Compliance Auditor
4 weeks ago
Analyzing and auditing LMC's systems of the Physician Network and hospital medical record data to ensure charges billed are supported by appropriate medical documentation is a key responsibility of this role. The Compliance Auditor will monitor risk areas and conduct focused audits as identified by the Compliance Audit Manager. They will prepare reports and meet with physicians and Advanced Practice Providers (APPs) to review audit results.
Key Responsibilities- Conduct audits of hospital and Physician Network records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid, and third-party billing regulations and/or standards.
- Assist the Chief Compliance Officer in investigating inquiries related to erroneous billing and coding of services.
- Work closely with other departments, Health Information Management, and Revenue Integrity to conduct coding reviews and inquiries.
- Draft formal written reports summarizing medical record findings for review.
- Provide education on subjects pertinent to reviews conducted and any coding and billing changes to appropriate LMC staff.
- Determine whether medically necessary criteria are met as required by CMS and the fiscal intermediary through National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and other guidance in effect at the time of the review.
- Bachelor's Degree in Business or a related field.
- Minimum 3 years of directly related experience.
- Substitutable Education & Experience: A Bachelor's and 3 years of experience can be substituted for the following combinations of education/work experience:
- High School Diploma with 7 years of directly related experience.
- Associate's Degree with 5 years of directly related experience.
- Required Certifications/Licensure: Certified Professional Coder (CPC) Certification through AAPC or Certified Coding Specialist (CCS) through AHIMA.
- Required Training: Strong problem-solving skills, ability to articulate orally and in writing an understanding of complex issues and detailed action plans, while representing the organization professionally.
- Day ONE medical, dental, and life insurance benefits.
- Healthcare and dependent care flexible spending accounts (FSAs).
- Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
- Employer-paid life insurance – equal to 1x salary.
- Employee may elect supplemental life insurance with low-cost premiums up to 3x salary.
- Adoption assistance.
- LHI provides its full-time employees employer-paid short-term disability and long-term disability coverage after 90 days of eligible employment.
- Tuition reimbursement.
- Student loan forgiveness.
Lexington Medical Center is an equal opportunity employer and strives to provide a discrimination-free environment. We recruit, select, onboard, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation.
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