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Regulatory Compliance Auditor

2 months ago

Baltimore, Maryland, United States Johns Hopkins University Full time

Position Overview
We are looking for a dedicated Compliance Auditor to deliver audit and research assistance to healthcare professionals, including physicians, non-physician providers, billing staff, clinic personnel, and administrative teams regarding documentation and billing standards.

Key Responsibilities
Utilizing established auditing and research methodologies, assess the sufficiency of medical records documentation, coding, and billing practices across various clinical specialties. Collaborate closely with Senior Auditors, Trainers, Leads, Managers, and Directors to contribute to the creation and enhancement of relevant training and educational materials.

Assist in generating reports for senior leadership and clinical departments concerning the outcomes of audits and reviews. The documentation audits are integral to the Billing Quality Assurance Compliance Program.

Specific Duties
1. Conduct independent evaluations of medical record documentation to ensure it supports the codes chosen by providers or billing office coders.
2. Investigate and resolve billing and documentation inquiries submitted by faculty, departments, and billing staff to maintain compliance with payer regulations and institutional policies.
3. Verify and amend audit work completed by other auditors as necessary.
4. Analyze documentation or coding trends that may present compliance risks and offer recommendations for improvement.
5. Aid in the development of training sessions for providers and billing staff on a scheduled or as-needed basis.
6. Participate in feedback sessions with providers alongside Senior Auditors to discuss the findings of medical record documentation reviews.

Support Functions
Assist management in preparing and updating a Compliance Training Manual for routine and specialized training initiatives. Contribute to the research and formulation of medical record documentation standards related to clinical service billing. Stay informed about third-party regulations, particularly concerning Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.

Qualifications
Minimum Requirements:
- Bachelor's Degree in a healthcare-related or business-related field.
- At least two years of experience in auditing or billing compliance.
- A minimum of one professional coding certification (CCS-P, CPC, RHIA, or RHIT) is required upon starting.
- Knowledge of Medical Terminology and Anatomy & Physiology is essential.

Preferred Qualifications:
- Five years of relevant experience is preferred.
- Additional coding certifications are advantageous.

Physical Requirements:
- Ability to sit for extended periods.
- Reach by extending hands or arms in any direction.
- Finger dexterity for manipulating objects, such as using a keyboard.
- Effective communication skills, including verbal communication.
- Ability to see and hear within normal ranges and to move about as necessary.

*This description outlines the primary duties and responsibilities typically performed on a regular basis and does not exclude other tasks as assigned.