Compliance Medical Auditor And Educator

Position Summary:

The Compliance Medical Auditor and Educator will work with the Compliance Medical Auditor Team Lead to perform coding and billing compliance audits for the Ob Hospitalists. Provide education to hospitalists and staff on appropriate coding and medical record documentation, based upon coding guidelines and regulations. Assist with other coding compliance activities.

Compliance Medical Auditor and Educator Position Responsibilities:

• Conduct billing and coding compliance audits, which may include review of in-patient and out-patient medical records to determine appropriateness of documentation, procedure and diagnosis coding, and evaluation and management coding. Audits will involve professional billing.

• Conduct analysis and be able to apply state and federal healthcare or related regulations to different questions, projects or inquiries presented to the Compliance Department.

• Under the direction of the Director of Compliance and the Compliance Medical Auditor Team Lead, works with the Patient Keeper project to provide the coding education needed for the Ob hospitalists.

• Conduct compliance education sessions with the practitioners and other staff who may be involved in coding and billing.

• Handle inquiries from the Department's customers on billing and coding compliance-related questions.

• Assist in the development and roll out of policies and procedures related to auditing, billing and coding.

• Use a standardized audit tool or tools, including those within Healthicity, for all audits that are in place.

• Plan and perform work in accordance with internal standards developed by the Compliance Office.

• Create and utilize a standard audit finding report for communicating the results of the audits in a clear, concise manner.

• Handle telephone calls in a professional manner; screen all telephone calls and inquiries. Maintain an awareness of compliance office projects within the department.

• Assist the Senior Compliance Medical Auditors and Educators with their coding compliance audits, as necessary.

• Perform Healthmap- and EMR access-related duties to assist and back up the HIM Specialist.

• Perform other related duties as assigned.

Essential Skills/Credentials/Experience/Education

• Certified Professional Coder (CPC) from AAPC or Bachelor's degree.

• Knowledge of medical terminology and anatomy and ancillary tests/procedures a must.

• Excellent organizational skills and strong attention to detail required.

• Working knowledge of Medicaid coding regulations is preferred.

• Awareness of and compliance with HIPAA (Health Insurance Portability and Accountability Act) and related healthcare privacy regulations.

• Skill in operating a personal computer; must be proficient in Word, Excel, Power Point.

• Ability to compose letters, memos, and other correspondence.

• Effective interpersonal skills required in interactions with Ob Hospitalists and personnel.

• Ability to work independently with minimal supervision required.

• Ability to work with highly confidential materials.

• Must possess high ethical standards.

• Experience preferred in educating physicians regarding coding, charting and other relevant processes, in an individual and or group setting.

Mental and Physical Demands (per ADA guidelines) The below demands are intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

Physical Demands:

• Sitting Constantly (67 - 100%)
• Talking on the phone and in person frequently (34 - 66%)
• Walking/Standing Occasionally (0 - 33%)

Travel Demands: Travel 0-10%.

Other: Occasional calls in the early evening hours (between 5:00 and 7:00 ET weekdays) may be necessary to accommodate the availability of OBHG Hospitalists in other time zones.

Hourly, Nonexempt Compensation: $25.00 - $26.00 per hour

What We Offer - The Good Stuff:

• A mission based company with an amazing company culture.

• Paid time off & holidays so you can spend time with the people you love.

• Medical, dental, and vision insurance for you and your loved ones.

• Health Savings Account (with employer contribution) or Flexible Spending Account options.

• Employer Paid Basic Life and AD&D Insurance.

• Employer Paid Short- and Long-Term Disability.

• Optional Short Term Disability Buy-up plan.

• Paid Parental Leave (starting June 1, 2024)

• 401(k) Savings Plan, with ROTH option.

• Legal Plan.

• Identity Theft Services.

• Mental health support and resources.

• Employee Referral program - join our team, bring your friends, and get paid.