Audit & Compliance Specialist

Administrative/Clerical Lawrence, Kansas


Description

JOB SUMMARY

The Audit & Compliance Specialist conducts prospective and retrospective compliance reviews of documentation supporting codes reported by providers to ensure accuracy in billing, maximize charge capture, and comply with Federal, State, payer and institutional requirements.  Through the review process, the Coding Compliance Specialist may identify opportunities to improve coding practices and related business processes or issues needing further review, assessment and follow-up.  The Coding Compliance Specialist supports the Compliance Management team in its objective to assure that practitioners and staff are knowledgeable as to the requirements for documenting, coding and billing clinical services in a complex and ever-changing regulatory environment.
ESSENTIAL JOB RESPONSIBILITIES

  1. Coding and auditing of professional E/M services and procedures to ensure accuracy and capitalize on revenue potential
  2. Audits of new physicians on coding and documentation requirements for E/M services and procedures
  3. Track coding issues by provider and present necessary education and training to improve coding
  4. Demonstrate a thorough knowledge of complex coding, reimbursement, and health information processes and understanding of the principals of auditing
  5. Keep informed of third party regulations in billing/reimbursement, professional standards, and organizational policies
  6. Provide telephone and email support to staff that have coding questions
  7. Assist in the development of written policies and procedures, auditing methodology, audit tools, and guidelines for the department in collaboration with appropriate operation areas
  8. Perform other integral audit duties as assigned
  9. Perform routine and targeted Electronic Medical Record (EMR) auditing and monitoring to ensure privacy and integrity of Patient Health Information (PHI).
  10. Independently researches and validates PHI and Compliance Audit findings.
  11. Perform organizational compliance risk assessment to identify strengths, vulnerabilities, and risks, and make recommendations, develop action plans, and monitor compliance with those recommendations to ensure proper correctional steps have been implemented.
  12. Assists Director in investigating HIPAA and Compliance issues, reporting as necessary to affected individuals and to OIG, DOJ, Secretary of Department of Health and Human Services (DHHS) and all other pertinent regulatory entities, and monitoring organizational compliance initiatives and risk areas.
  13. Implements and executes compliance audits and special projects as directed.
  14. Develop and present Orientation and ongoing training and education materials for for HIPAA and Compliance related training and education.
  15. Performs other duties as needed or assigned.

III. JOB QUALIFICATIONS
Required:

  • Certification in Physician Coding, CPC or CCS-P, required with in-depth knowledge of ICD/CPT coding
  • CEMC, Certification for Evaluation and Management Coder (AAPC) obtained within first year
  • Five years’ experience in physician coding and billing with working knowledge of healthcare operations.
  • Familiarity of documentation and coding requirements for physicians- including, but not limited to, Medical Staff By-laws, Clinical Standards, Regulatory Compliance, Risk Management, etc.
  • Ability to present findings and discuss issues with physicians confidentially and effectively
  • Excellent communication, organization, analytical, and problem-solving skills

Preferred:

  • Experience with recent Medicare audit in a physician practice setting

BEHAVIORAL EXPECTATIONS
(common to all positions)  

  • Patient 1st – We consider the patient first in everything we do.
  • Better Together – We are part of the LMH team that works together to achieve excellence.
  • Speak Up – We embrace a transparent culture of open, respectful communication where ideas are valued and solutions are created.
  • Innovate! – We actively explore new ideas and approach change with agility and an open mind.
  • Own It/Solve It – We hold ourselves accountable for our actions and we collaborate for solutions.
  • In Joy – We create a workplace that is both fun and meaningful.

At LMH Health we value inclusion and diversity. We are an equal opportunity employer and encourage all to apply.  Employment is decided on the basis of experience and qualifications that meet the business need.