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Compliance Auditor

  • POSITION SUMMARY
    • The Compliance Auditor plans, schedules, and performs comprehensive internal professional fee audits to include routine and focused audits. Performs detection of documentation, coding, and billing errors as well as collaboration with appropriate stakeholders to ensure correction and/or appropriate response to identified issues. Communicates audit results to providers, coders, management, and other appropriate staff. Develops and delivers provider and coder education. Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to regulatory compliance with guidelines related to professional fee documentation, coding, and billing. Stays abreast of documentation, coding, and billing regulations and standards and serves as a subject matter expert on interpretation and application of documentation and coding rules and regulations.
  • JOB SPECIFICATIONS
    • EDUCATION
      • Associate's/Bachelor's degree preferred or high school diploma with requisite experience
    • LICENSURE
      • n/a
    • EXPERIENCE
      • Must have 5 years experience as a coder in a hospital or clinic environment. Prefer 3 years auditing experience in a hospital or clinic environment, as well as familiarity with hybrid and split billing. Prefer experience with Epic as the electronic medical record. Extensive knowledge of evaluation and management coding, modifiers, provider-based billing, and auditing principles are required. Knowledge of federal, state, and private payor guidelines and internal billing guidelines/procedures. Ability to provide feedback to medical providers, coders, and managers in a constructive way to promote learning and collaboration. Strong verbal and written communication skills. Effective time management skills. Proficient with web tools and Microsoft Office. Ability to develop and deliver education to various stakeholder audiences. Must be able to maintain the highest level of confidentiality of sensitive information
    • CERTIFICATION
      • Must posses an AAPC coding certification (such as CPC) and specialty certification preferred. Must have auditing certification of CPMA or other accredited auditing certification, or ability to obtain such certification within 12 months of hire date

Compliance Auditor

Full time
Hendersonville, NC

Published on 09/10/2019

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