• Act as a subject matter expert by providing resources, assistance and E/M experience to audits and investigations
• Apply knowledge of ICD-10 and CPT coding guidelines during the audit/investigation of providers and specialized services on a routine basis to ensure compliance with Medicare, other federal insurance programs and third-party regulations
• Provide education and training to internal departments and providers as needed
• Via audits/investigations, identify charges that need correction due to erroneous billing
• Utilize data available to identify high-risk areas for auditing and monitoring
• Perform 'targeted audits' as identified by the Revenue Cycle/Claims Compliance program risk assessment/work plan, inclusive of OIG related topics/risk areas
• Report audit/investigative findings, inclusive of incidents of non-compliance and discrepancies to the Compliance Manager, Revenue Cycle/Claims Audits & Investigations
• Provide training for non-compliant providers on documentation guidelines. Monitor for ongoing compliance.
• Participates in enterprise, interdisciplinary and cross-functional committees as assigned by the Billing and Coding Compliance Audit Manager
• Maintains necessary professional certifications, professional association memberships via ongoing education and training in the respective field
• Other duties as assigned

Working Conditions: Standard office conditions
Education Required:

• Associate degree in Business or Healthcare field.
• Certified Professional Coder (CPC) required, or Certified Coding Specialist (CCS), or Certified Coding Specialist Physician (CCS-P)

Education Desired:

• Certified in Healthcare Compliance (CHC) within two years of hire

Experience Required:

• 5 years billing/coding/reimbursement or auditing/investigative work experience within organizational compliance or internal audit programs
• Experience with computer systems required, including web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint, or Access.

Knowledge, Skills & Abilities Required:

• Strong knowledge of reimbursement regulations, coding guidelines and compliance policies
• Current knowledge of ICD-10 and CPT Coding, medical terminology, Medicare, other federal insurance programs and third-party billing, and compliance regulations and guidelines.
• Self-motivated, ability to work independently, good interpersonal skills; must possess integrity.

Language(s) Required:

• English

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job Type: Full-time

Schedule:

• 8 hour shift

Work Location: One location

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