Compliance Auditor

4 weeks ago

Baltimore, United States Johns Hopkins University Full time

We are seeking a Compliance Auditor who will provide audit and research support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditor/Trainers, Leads, Manager and Director to provide input and assist in the development of any applicable training and education content. Assists in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine's Billing Quality Assurance Compliance Program. Specific Duties & Responsibilities Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders. Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures. Verifies and corrects as necessary, the audit work completed by the Auditors. Reviews documentation or coding patterns by a provider, division or department that poses a compliance risk and provides input on recommended solutions. Assist with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis. Participate in provider feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation reviews and provides input and support as needed. Supports the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs. Assists in the research and development of medical record documentation standards and requirements related to clinical services billing. Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing. Performs other compliance related activities as necessary. Minimum Qualifications Bachelor's Degree in health care-related or business-related field. Minimum of two years of auditing/billing compliance required. A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date. Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required. Preferred Qualifications Five years of experience preferred. Additional coding certifications preferred. Physical Requirements Sitting in a normal seated position for extended periods of time. Reaching by extending hand(s) or arm(s) in any direction. Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard. Communication skills, using the spoken word. Ability to see within normal parameters, ability to hear within normal range and ability to move about. *This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned. #J-18808-Ljbffr

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