Compliance Integrity Auditor

Non-clinical United States United States


Description

Talkiatry transforms psychiatry into the accessible, human, and empowering experience it should be.

We were co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality mental healthcare. 60% of adults in the U.S. with a diagnosable mental illness go untreated every year because care is inaccessible, while 45% of clinicians are out of network with insurers because reimbursement rates are low and paperwork is unduly burdensome. With innovative technology and a human-centered philosophy, we provide patients with the care they need—and allow psychiatrists to focus on why they got into medicine.  

Talkiatry is actively seeking a Compliance Integrity Auditor who will be responsible for QA’ing the work of medical coders and billers. In this role, they will be responsible for identifying incomplete documentation by examining coding procedures, thereby ensuring the organization complies with regulatory requirements. A medical auditor would be expected to identify fraudulent claims, outliers, reimbursement deficiencies, inefficiencies, incorrect codes, and poor documentation to protect the integrity and accuracy of the billing process and illuminate non-compliant billing practices. They also provide education, as necessary, to other healthcare professionals regarding correct documentation and detailed recommendations to improve the organizations procedures and policies. This role reports directly into the Chief Compliance Officer.

Responsibilities: 

  • Perform coding compliance audits of claims to assure appropriateness and accurate code assignments in accordance with established guidelines
  • Provide ongoing feedback and analysis of the education needs for the providers and staff
  • Denials analysis and trend recognition, underpayments analysis and related corrective actions
  • Compliance with regulatory and payer billing requirements and charge capture process improvement
  • Will be identified as organizational resource on billing compliance matters and will work with clinical departments to ensure that appropriate claims controls are in place
  • Participate in and/or lead inter-departmental process improvement initiatives
  • Perform concurrent review of claims to revise for proper documentation
  • Analyze and review audit data to prepare reports for Chief Compliance Officer, Revenue Cycle Department, and clinical provider teams
  • Post- review / audit education and training when applicable
  • Assist in development of internal compliance policies that establish standard procedures for relevant staff members

Qualifications: 

  • Bachelor’s degree in health information management, certified professional medical (CPMA) auditor and/or coder (CPC)
  • Understanding of critical coding concepts and medical record auditing skills
  • Certification as a professional medical auditor
  • Requires 3 - 5 years previous experience in healthcare revenue cycle compliance, preferably in the behavioral health setting
  • Must have extensive knowledge of E&M, CPT, HCPCS, revenue codes and ICD-10/DSM-5 coding
  • Able to analyze and identify opportunities in documentation improvement
  • Electronic health record experience preferred
  • Impeccable attention to detail and accuracy
  • Promote and enhance communication between practice administration and provider teams
  • Demonstrated understanding of compliance program elements and applicable laws/ industry regulations
  • Ability to work without direct supervision completing time sensitive assignments

We Offer: 

  • A collaborative, diverse, fast-paced environment in a purpose-driven company
  • Flexible Location: Colleagues may work virtually in a remote environment, or out of our NYC office
  • Opportunity to learn and grow as our organization grows thanks to a best-in-class Learning team
  • Support from our leadership team that is committed to building a people-first, inclusive culture focused on your well-being and supporting your wellness ambitions
  • Generous benefits including up to 100% of healthcare insurance costs paid from day 1, competitive 401K with match, generous PTO, plus paid holidays, and more!

At Talkiatry, we are an equal opportunity employer committed to a diverse, inclusive, and equitable workplace and candidate experience. We strive to create an environment where everyone has a sense of belonging and purpose, and where we learn from the unique experiences of those around us.

We encourage all qualified candidates to apply regardless of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status.