Senior Compliance Auditor

POSITION SUMMARY:

Under the general supervision of the Manager of Compliance Audit, the Senior Compliance Auditor is primarily responsible for the execution of the yearly billing compliance workplan and participates in the yearly billing compliance clinician education workplan. This position will be responsible for ensuring timely completion of billing compliance audits from the compliance audit team. This includes quality checks of the audits performed by other staff, development of audit reports, meeting with clinicians to review draft audit reports, as well as the finalization of reports, presenting information to departments upon request, and tracking completing audits and reporting to leadership when requested. The Senior Compliance Auditor is seen as a team leader and is expected to be very strong in both problem solving and conflict resolution/mediation.

Position: Senior Compliance Auditor       

Department: Compliance

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

1.          Responsible for conducting Evaluation and Management and procedure audits of electronic and paper medical records.

1.1       Complete audits in accordance with established schedule.

1.2       Manage and maintain thorough results/findings. Assign performance scores based on results.

1.3       Manage and coordinate data results via Access database.

1.4       Report aggregate and specific findings to the Director of Compliance on a monthly basis and as requested.

Conduct and support ongoing educational intervention and as required as a result of non-compliant activity with clinical and administrative staff as requested.

Assist in the implementation of coding and compliance policy and procedure.

5.         Prepare supporting materials for educational sessions with the assistance of reporting software.

6.         Maintain awareness of directives of government agencies and legislation as they relate to coding and compliance activities.

7.         Work in conjunction with Director of Compliance and appropriate staff to review audit results.

8.         Manage and maintain accurate information, including audit results and educational interventions, in compliance database.

9.          Identify opportunities for improvement and recognizes their relative significance in the overall system and provide recommendations regarding internal controls.

10.       Works with a variety of hospital based clinics, as needed, to provide assistance to clinical personnel with code selection.

11.        Provides positive and effective customer service that supports departmental and hospital operations.

12.        Develops and maintains professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations and review of current literature, consistent with Compliance Department program activities.

13.       Maintain a professional level of communication through emails, phone calls and business letters.

14.       Perform other related duties as required.

Must adhere to all of BMC’s RESPECT behavioral standards.

JOB REQUIREMENTS

EDUCATION:

Bachelor’s Degree

A combination of secondary education and compliance related job experience will be considered.

RN, other clinical degree or Master's Degree is desirable

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Certification through the AAPC (CPC, etc.) and/or AHIMA (CCS-P, etc.) is required. Certification through HCCA is desired

EXPERIENCE:

Minimum of 5 years of audit experience in a health care environment.

Provider education experience is also desirable.

KNOWLEDGE AND SKILLS:

• Candidate must be detail-oriented with excellent organizational and interpersonal skills. Candidate should have at least five years of experience reviewing physician documentation and assisting physicians to meet government and other third party payer and CPT and ICD--10 coding requirements through individual and group training sessions. Work requires knowledge of healthcare compliance regulations. Focused experience in one or more medical specialties is a plus.
• Work requires the analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems OR design relatively complex systems and programs that cross department/divisional lines.
• Work requires communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions, and well-developed writing skills.

Equal Opportunity Employer/Disabled/Veterans