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Senior Compliance Auditor

2 months ago

Lexington, Kentucky, United States Addiction Recovery Care Full time
Position Overview

Are you eager to contribute to a workplace recognized for its excellence? Addiction Recovery Care, LLC (ARC) has been acknowledged as one of the premier employers in Kentucky, reflecting the positive feedback from our dedicated staff.

We are committed to fostering an environment driven by shared objectives and a passion for enhancing the lives of our clients, patients, and team members. As a leader in the healthcare sector, ARC specializes in addiction treatment and mental health services, empowering individuals to find hope and realize their potential.

At ARC, we are excited to provide you with "The B.E.S.T. of ARC" (Balance, Energy, Safety, Training) from your first day. Our organization thrives in a dynamic and fast-paced healthcare environment where compassion, accountability, and respect for life are integral to our mission.

We are currently seeking a Compliance Auditor II to join our expanding team. This role operates under the guidance of the Vice President of Compliance and focuses on auditing financial aspects related to billing and coding accuracy. The Compliance Auditor II evaluates the precision of the company's claims records and ensures that the controls in place effectively mitigate risks associated with fraud, abuse, and resource wastage. Additionally, this position involves conducting various non-billing audits to assess compliance in other identified risk areas.

Key Responsibilities:

  • Compile, analyze, and verify medical records and other relevant data to perform thorough audits of client medical records according to established policies and procedures.
  • Ensure the accuracy of facility records to prevent mismanagement, fraud, and abuse.
  • Observe clinical service delivery to evaluate compliance with ARC policies, legal regulations, and accreditation standards.
  • Prepare and present audit findings, conclusions, and recommendations to the VP of Compliance and relevant stakeholders in a timely manner.
  • Assist in developing and implementing audit recommendations and follow-up actions, including adjustments and rebilling.
  • Conduct chart audits and monitor departmental action plans to ensure resolution of identified issues.
  • Audit patient accounts for accuracy and completeness of information.
  • Ensure correct ICD-9/ICD-10 and CPT coding on patient accounts.
  • Identify and report discrepancies promptly.
  • Maintain knowledge of current Medicaid requirements and regulatory guidance from the Centers for Medicare and Medicaid Services (CMS).
  • Stay informed about the facility's EMR and billing systems.
  • Evaluate documentation compliance with current standards and policies.
  • Perform follow-up audits to verify implementation of corrective actions.
  • Foster collaborative relationships within the department and across the organization.
  • Demonstrate flexibility, organization, and the ability to perform under pressure.
  • Adhere to policies, performance improvement objectives, and safety standards.
  • Engage in continuous education and stay updated on relevant compliance topics.
  • Uphold patient confidentiality at all times.
  • Support a culture of safety and quality.
  • Perform additional duties as assigned.

Qualifications:

  • Experience in auditing and/or coding is required.
  • Background in healthcare or behavioral health settings is essential.
  • Strong verbal and written communication skills, with the ability to convey complex concepts effectively.
  • A post-secondary degree with relevant work experience is necessary.
  • Experience in a behavioral health environment is preferred.
  • Ongoing education in behavioral health is advantageous.
  • Proficiency in information technology is required.
  • Working knowledge of HIPAA compliance is essential.

ARC offers a comprehensive benefits package for full-time employees, including health, dental, vision, life insurance, and a 401(k) plan with company matching. We also provide generous paid time off policies to support work-life balance.

At Addiction Recovery Care, LLC, we are dedicated to transforming lives through strong family relationships, social responsibility, and meaningful career paths.