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Compliance Auditor
5 months ago
Review data, such as billing, coding, financial, and medical record documentation to determine compliance with applicable regulations, policies, and requirements. Assist with internal audits and regulatory risk assessments. Research, interpret and communicate federal and state laws and guidelines pertaining to Medicare and Medicaid to relevant parties.
Plan and conduct internal coding, billing and documentation audits as part of the internal auditing team. Must possess ability to write detailed audit reports and communicate findings to YKHC leadership. Assist and work collaboratively with external compliance auditing consultants communicating audit planning and findings to YKHC leadership. Ability to interact positively with senior management and department managers. Perform routine monitoring in certain highly regulated or high-risk billing and clinical areas in an effort to prevent and detect improper claims or other transactions.
Mix of job responsibilities may vary with departmental functions.
Position Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and other duties as assigned.
Ideal candidate will have knowledge of medical billing, medical coding, accounting, compliance principles and regulatory standards. Ability to work independently and as a team player.
Bachelor’s Degree in Accounting, Business, or healthcare-related field preferred. Relevant years of experience in lieu of a degree will be considered.
Two (2) years of experience in healthcare billing, auditing or coding preferred. Work experience sufficient to have acquired and developed the knowledge, skill, and ability to perform the functions of the position.
Must have experience working with confidential, detailed processes, excellent organizational skills, customer service and presentation skills.
Preferred experience in medical billing, coding, accounting, financial analyst or healthcare related field.
Certified Public Accountant (CPA), Certified Professional Coder (CPC), Certification in Healthcare Compliance (CHC ) , or Certified Internal Auditor (CIA) eligible preferred but not required.
Candidate will be required to obtain Certification in Healthcare Compliance (CHC) within 2 years from hire date.
Continued strong desire to obtain additional credential(s) preferred.
Computer proficiency with various software and database systems, calculator, multi-line phone, fax/copy machine.
Intermediate to advanced computer proficiency skills preferred. Preference will be given to candidates possessing experience with GRC software, ability or experience with data analytics and/or computer scripting.
Microsoft Word, Excel, and Access; Computer skills with ability to type 40 wpm; operate 10-key calculator and other standard office equipment.
Must be able to complete a variety of tasks simultaneously, prioritize workload, and meet reporting and completion deadlines with attention to detail. This position requires an extremely perceptive person, who is capable of relating to individuals at all levels. Must have excellent analytical, organization, interpersonal and written/oral communication skills.
As unique situations present themselves, the incumbent must be sensitive to Corporate needs, employee goodwill, and the public image. Ability to make decisions in a timely manner on limited but adequate information.
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