Physician Compliance Auditor 2

Job Summary:

• Currently, there is only one level of Physician Compliance Auditor.
• Even though there are some more advanced and knowledgeable Physician Compliance Auditors, they all have the same designation.
• A great dissatisfier repeatedly in the People Survey has been the lack of opportunities for advancement in Compliance.
• Risk Management and Revenue Cycle Management both have several levels of coders/auditors.
• This would help to give Physician Compliance Auditors an additional position to aspire to.
• Information highlighted in red highlights the differences between Physician Compliance Auditors I and II.

Duties and Responsibilities:

• Perform annual chart audits (mostly in their areas of expertise) and formulate recommendations based upon the audit findings and communicate them to the appropriate personnel.
• Implement annual coding reviews and ensure that compliance issues and areas of risk are identified and addressed.
• Develop curriculum to be used in orienting and educating providers and staff in the specialty clinics to medical record documentation guidelines and standards and to diagnostic and procedural coding conventions and methodologies.
• Assist in specialty coding educational sessions with Revenue Cycle Management (RCM) and Risk Based Coding.
• Coding compliance resource and consultant for all physicians and advance practice providers, company administrators and physician practice staff.
• Prepare and submit compliance reports to the compliance committee.
• Serve as a coding and documentation resource to Physician Coding Auditors I and RCM on specialty (cardiology, neurology, orthopedics, etc.) coding.
• Cross-train other Physician Coding Auditors in their area(s) of expertise in order to provide more depth and flexibility to the department.
• Maintain working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the compliance department.
• Special projects as needed.
• Performs other position appropriate duties as required in a competent, professional and courteous manner.

Required Certifications:

• CPC, CCS, RHIT - must have one and Please attach in resume.

Required Experience:

• Provider education/audit required, 5 years exp minimum, epic is preferred.
• Consulting exp is highly preferred.

Knowledge, Skills and Abilities:

• Knowledge of CPT, ICD-10 and HCPCS.
• Ability to research topics regarding compliance and coding efficiently and accurately.
• Able to clearly and concisely explain compliance concerns and resolutions with the ability to comfortably discuss the same with all members of the organization.
• Proficient in Word, Excel, and PowerPoint.
• Four years auditing experience.

Interview Type:

• 2 rounds of interviews.