Clinical Compliance Auditor
2 weeks ago
Summary
The Clinical Compliance Auditor plans, schedules, and performs comprehensive internal professional fee audits to include routine audits, focused audits, for cause audits, and not for cause audits for Chesapeake Regional Healthcare (CRH) and all of its affiliated entities. Performs detection of documentation, coding, and billing errors as well as collaboration with appropriate stakeholders to ensure corrective action and/or appropriate response to identified issues.
Essential Duties and Responsibilities
- Plans, schedules, and performs comprehensive internal professional and hospital fee audits as determined by the Compliance Work Plan to include routine and focused audits.
- Detection of documentation, coding, and billing errors as well as collaboration with appropriate stakeholders to ensure corrective action and/or appropriate responses are implemented to address identified issues.
- Communicates audit results to providers, coders, management, and other appropriate staff and makes recommendations to ensure sustained compliance and improvement.
Education and Experience Requirements
Clinical Requirments:
- Registered Nurse
- Experience as a coder in a hospital and/or healthcare environment
- Extensive knowledge of evaluation and management coding, modifiers, provider-based billing, and auditing principles American Academy of Professional Coders (AAPC) coding certification (such as Certified Professional Coder (CPC) or dual CPC and Certified Professional Biller (CPB))
- Experience in healthcare revenue cycle, auditing, clinical operations and/or compliance preferred.
- Knowledge of DRG, CPT, CDM and billing operations
- Knowledge of hospital department operations.
- Knowledge of and experience with EPIC and Athena electronic medical records
Non - Clinical Requirements
- Experience as a coder in a hospital and/or healthcare environment
- Extensive knowledge of evaluation and management coding, modifiers, provider-based billing, and auditing principles American Academy of Professional Coders (AAPC) coding certification (such as Certified Professional Coder (CPC) or dual CPC and Certified Professional Biller (CPB))
- Experience in healthcare revenue cycle, auditing, clinical operations and/or compliance preferred.
- Knowledge of DRG, CPT, CDM and billing operations
- Knowledge of hospital department operations.
- Knowledge of and experience with EPIC and Athena electronic medical records
Preferred
- Three (3) years auditing experience in a hospital and/or healthcare environment
- Bachelor’s degree in Nursing, Healthcare Administration, Business, and/or Accounting
- Auditing certification such as Certified Professional Medical Auditor (CPMA) or other accredited auditing certification
- Health Care Compliance Association (HCCA) membership and certification
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