Compliance Auditor - Memorial Healthcare System : Job Details

Summary:

Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.

Responsibilities:

• Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.
• Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.
• Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.
• Follow up on audit findings to ensure that the corrective action plans are effective.
• Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.
• Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.
• Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.
• Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.
• Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.

Education and Certification Requirements: Associates (Required) Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)

Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.

Other Information: Additional Education Info: Associate's degree in Health Information Management, Health Information Technology, Health Informatics, or related field. Bachelor's Degree preferred. Additional Certification Info: Certified Coding Associate (CCA from AHIMA) or Medical Coding Certificate required. Certificated as a Professional Medical Auditor preferred.