Regulatory Auditor

2 months ago

Washington, Washington, D.C., United States MEDSTAR HEALTH Full time

General Summary of Position

MedStar Physicians' Billing Services is currently seeking an experienced Regulatory Auditor to join our team The qualified candidate must be a CPC Medical Coder that thrives working independently in a fast-paced environment.

Position is REMOTE but we are seeking a local candidate to the DMV Area (Washington DC, Maryland, Virginia).

Join one of the largest health systems in the area and enjoy the benefits of a comprehensive benefits package including paid time off, health/vision/dental insurance, short & long term disability, tuition reimbursement and the benefits of remote work capability.

Job Summary - Receives, documents, and monitors regulatory guidance from governmental and commercial payers. Coordinates required change to ensure that MPBS systems and practices adhere to all specifications while maintaining revenue cycle optimization. Facilitates MPBS response to audit inquiries. Develops educational materials and programs to promote client provider accuracy and completeness of medical documentation, coding, and billing in accordance with Federal, State and payer regulatory requirements.

Primary Duties and Responsibilities

Continuously monitors Federal and State (Medicare and Medicaid) program advisories to ensure that MPBS systems and practices are functioning in accordance with regulatory guidelines. Maintains a repository of program memorandums by payer (both governmental and commercial) detailing coding and billing practice requirements.Develops and delivers communication to client departments/clinicians regarding changes in regulatory environment and their potential impact on revenue optimization.Exemplifies Guest and Staff Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds staff accountable for conformity with those standards in all activities.Facilitates responses to all payer audits, including but not limited to: ADR's, CERTS, RACs, medical record requests, coding issues, and LMRP's. Responsible for the daily oversight and the transfer of data between the MPBS and the impacted providers/entities, and ensures that inquiry responses are completed within mandated timelines.Identifies potential areas of regulatory vulnerability and risk for MPBS related processes and work product. Researches, writes and obtains necessary approval for changes to MPBS policies and procedures for the resolution of process and work product issues to the MPBS management team.Prepares and submits weekly issue logs and tracking reports detailing State and Federal regulations and commercial payer, regulatory guidance, audits, denials, advisories and any other related communication that may impact MPBS systems and practices. Represents MPBS on MedStar Compliance Committees. Manages and maintains MPBS response to MedStar Compliance Committees related audits/reviews or other risk assessment activities.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.Performs other duties as assigned.

Minimum Qualifications
Education

  • Bachelor's degree in health related or business administration preferred
  • Any other combination of relevant education and/or experience will be accepted.

Experience

  • 3-4 years progressively responsible experience in operational, clinical, business management or similar field required

Knowledge, Skills, and Abilities

  • Excellent project management skills.
  • Strong knowledge of healthcare compliance, regulatory law, CMS billing rules, and OIG projects preferred.
  • High level of independent judgment and problem-solving skills.
  • History of effective working relationships with other health professionals.
  • Excellent verbal and written communication skills.
  • Strong analytical, report design and organizational skills.
  • Strong public speaking and presentation skills.
  • Proficiency in computer software programs including MS Office.
  • Ability to work and thrive in team oriented, production and deadline driven work environment.

This position has a hiring range of $63,
$107,411.20

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