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Compliance Auditor

1 month ago

Lake City, United States Grady Health Full time

Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages on your career, you can find a rewarding career at Grady SUMMARY As a member of the Compliance team, the Compliance Auditor is responsible for leading and conducting key activities of Grady Health System’s audit program. The Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters and other compliance issues as directed by the Compliance Director and the Chief Compliance Officer. This position requires effective communication with internal stakeholders and external auditors. Candidate should possess excellent organization skills to ensure accuracy and timeliness of audit results. QUALIFICATIONS · Experience conducting independent audits to assess risk with regulatory standards and writing formal reports · Minimum of five (5) years’ experience in an acute care inpatient and/or outpatient settings · Experience conducting medical coding, medical necessity, claims denial, bundling, and reimbursement audits · Working knowledge in the assignment of ICD-9-CM, ICD-10-CM, CPT, HCPCS and MS-DRG/APC classifications and reimbursement methodologies · Strong verbal and written communication skills · Strong analytical and critical thinking skills · Ability to work independently · Ability to handle multiple priorities and deadlines EDUCATION · Associates degree in Business, Healthcare, Nursing (ASN) or other related field required · Bachelor’s Degree in Business, Healthcare, Nursing preferred · Bachelor of Science in Nursing (BSN) preferred · Master of Science in Nursing (MSN) preferred CERTIFICATES, LICENSES, REGISTRATION · One of the following coding certifications through American Health Information Management Association or the American Academy of Professional Coders required: o Certified Coding Specialist (CCS) o Certified Coding Specialist – Physician (CCS-P) o Certified Professional Coder (CPC, formerly CPC-H) o Certified Outpatient Coding (COC) · Certification in Health Care Compliance (CHC) preferred · Registered Health Information Technician (RHIT) preferred · Registered Health Information Administrator (RHIA) preferred · Certified Internal Auditor (CIA) preferred · Certified Health Care Compliance (CHC) preferred · Certified Healthcare Auditor (CHA) · Certified Healthcare Internal Audit Professional (CHIAP) preferred · Meet annual requirements to maintain certification, license and registrations COMPUTER SKILLS: · Strong working knowledge in Microsoft Word, Excel, Power Point and Outlook required · Experience with electronic medical records and billing platforms · Ability to learn new systems quickly