Sr Compliance Auditor II

  • Carolinas Healthcare System
  • Charlotte, NC, USA
  • Feb 10, 2018
Full time Healthcare

Job Description

Location Details:  Airport Center
Job Summary
Performs compliance coding and billing audits to evaluate the appropriateness of medical records to support accurate claims. Coordinates pre-audit strategic plan with management and directs the exit interview proceedings with facility management. Provides enterprise-wide education to facility coders and billing staff on a regular basis. Participates in compliance investigations that may include the conduct of concurrent or retrospective audits which could result in an internal or external inquiry. Works in a group or team environment and may assist other Corporate Compliance Department staff with auditing projects, as assigned.

Essential Functions
  • Develops written reports communicating audit findings, operational/financial impacts and recommendations for improvements and enhancements.
  • Serves as an educational resource for compliant practices as required by the Centers for Medicare and Medicaid Services and other regulatory agencies.
  • Reviews medical and financial records to evaluate appropriateness of clinical documentation and reimbursement for healthcare services.
  • Analyzes audit findings to assess healthcare documentation practices in relation to regulatory requirements of federal payers.
  • Performs validation and other focused audits of high risk services and specialty areas with complex coding and billing regulations.
  • Prepares operational and financial impact reports based on audit findings.
  • Develops and coordinates compliance educational and training materials.
  • Collaborates with staff to resolve identified compliance issues.
Physical Requirements
Work requires the ability to function in an office environment. Must be able to travel to different facilities.

Education, Experience and Certifications
Bachelors Degree in a healthcare or clinical field required. Education in ICD-9-CM and HCPCS coding required. 5 years experience in healthcare compliance or healthcare audit. Extensive knowledge of Medicare and Medicaid regulations. Extensive knowledge of healthcare clinical documentation requirements.

At Carolinas HealthCare System, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.
As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.
Posting Notes: Not Applicable
Carolinas HealthCare System is an EOE/AA Employer