Compliance Auditor jobs at CommuniCare - 678 jobs

Compliance and Privacy Officer
Alameda County Health 4.4
San Leandro, CA jobs
PLEASE READ THIS JOB ANNOUCEMENT IN ITS ENTIRETY. An Alameda County Job Application is required to be considered for ALL County recruitments. Compliance and Privacy Officer Alameda County Health, Behavioral Health Department is recruiting for its next: Compliance and Privacy Officer $140,088.00-$170,289.60 Annually Placement within this range is dependent upon qualifications. Plus, an excellent benefits package! This is a provisional recruitment. *For a provisional appointment, a civil service exam is not required. However, to obtain a regular position, the appointee will need to compete successfully in a County Exam when open. This position requires CA residency. Please do not hesitate to contact Tyler (*********************), if you have any questions regarding the position or recruitment process. About Us As part of Alameda County Health, the Behavioral Health Department supports people with Medi-Cal and without insurance living with serious mental illness and substance use conditions along their path toward wellness, recovery, and resiliency. We provide services through a network of contracted mental health and substance use providers and administer the State's resources and training for behavioral health providers, case managers, and other healthcare professionals. We advocate for our patients and families and create space for personal engagement in their care. We are outpatient specialists for mental health services for older adults and youth, substance use providers and treatment program specialists, advocates for quality improvement and patients' rights, and psychiatric and integrated health care providers. *********************** The POSITION Under general direction, the designated program Compliance and Privacy Officer (CPO) plans, organizes, directs, monitors, and promotes an effective compliance and privacy program. This position ensures that departmental compliance programs are consistent with Alameda County Health (ACH) Standards of Conduct and core values, policies and procedures, and promote adherence to applicable federal and state laws to advance the prevention of healthcare fraud, waste, and abuse, while providing quality care and services to those served by ACH; oversee all ongoing activities related to the development, implementation, maintenance, and adherence to ACH's policies and procedures covering the privacy of and access to protected health information (PHI) in compliance with applicable state and federal laws; and performs other related work as required. DISTINGUISHING FEATURES This classification is in ACH and reports to the Chief Compliance and Privacy Officer and is responsible for the broad coordination of the Department's comprehensive healthcare compliance and privacy assurance program. The incumbent is responsible for coordinating and performing activities related to education, training, auditing, and investigations to ensure employee awareness and compliance with the program and may serve as project manager overseeing the development, implementation, and maintenance of related programs. This classification is distinguished from the Quality Assurance Administrator classification which has primary responsibility for day-to-day operational issues focused on the appropriate and effective delivery of services to clients whereby this classification is focused on broader departmental-wide compliance activities. EXAMPLE OF DUTIES NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed. Implements and oversees the compliance and privacy program at departmental level to ensure the program meets the state/federal requirements and is aligned with the Alameda County Health Office of Compliance Services (OCS) Acts as a consultative resource for the entity leadership and associates on compliance and privacy matters. Provides overall leadership on issues concerning compliance and privacy, including developing and implementing controls designed to ensure compliance with applicable laws, rules and regulations, accurate coding and billing, contract agreements and detect and deter fraud, waste, and abuse. Identifies compliance vulnerabilities and risks, ensures that responses to reported concerns, alleged violations of the law, and/or conflict of interest, privacy, are reported in a timely appropriate, and consistent. Ensures the implementation and maintenance of an effective healthcare compliance and privacy program for the entity which will include conducting relevant risk assessments and developing risk-based compliance work plans. Maximize current strengths of the healthcare compliance and privacy program, identify and remedy gaps, proactively assess and address emerging compliance risks. .Leads and participates in Compliance Team Projects and initiatives when requested (e.g., exclusion monitoring, triennial audits, etc.) Oversees the implementation of corrective actions and monitoring in response to identified issues, audits, and annual work plan items. Independently investigates or supervises the investigation of compliance or privacy concerns raised through the Agency Helpline or other reporting mechanisms. Ensures distribution, implementation, and education regarding compliance policies and procedures, fraud waste and abuse, conflict of interest, code of conduct, billing and documentation, HIPAA privacy, and security awareness training. Participates in the development and implementation of annual work plan, enterprise risk assessment, and management and aligns entity risk assessment with the Agency risk management plans. Chairs or co-chairs the entity compliance and privacy committees and reports to the entity and Agency level leadership on compliance matters and progress on a regularly established frequency. Maintains knowledge of rules and regulations (healthcare compliance, HIPAA, HITECH, state privacy laws, etc.) that impact specific service areas and the organization and acts as a subject matter expert to support and provide guidance to workforce members. Develops and maintains collaborative relationships with leaders and stakeholders across the organization. Identifies opportunities and supports efforts to build a culture of compliance. Performs other duties as assigned. Compliance and Privacy Officer ********************************************************************************************************* MINIMUM QUALIFICATIONS EDUCATION: Possession of a bachelor's degree in public health, health care administration, social work, business administration, public administration, nursing, or a related field. AND EXPERIENCE: The equivalent of four (4) years of responsible, professional-level healthcare compliance and recent experience in one or more of the following areas in a healthcare delivery setting consisting of community health clinics, hospitals, skilled nursing facilities, physician practices, health insurance plans, or other healthcare settings with a focus on regulatory compliance, quality assurance, health care law and/or administration, risk management and/or regulatory investigations. CERTIFICATE: Possession of a Healthcare Compliance Certificate issued by the Healthcare Compliance Association's Certification Board. HOW TO APPLY Please email your County of Alameda Job Application, resume and cover letter to: Tyler (*********************) The application template is available online on Alameda County's Online Employment Center @ *********************************************************************** NEW USERS can click on “Fill out an application” to fill out an application template. Once the application is completed, candidates can click on the “Review” tab to “Print My Application” or “SAVE as PDF”. AN ALAMEDA COUNTY JOB APPLICATION MUST BE SUBMITTED TO ********************* TO BE CONSIDERED FOR THE POSITION. Alameda County HCSA is enriched with a diverse workforce. We believe the best way to deliver optimal programs and services to our communities is to hire and promote talents that are representative of the communities we serve. Diverse candidates are strongly encouraged to apply. BENEFITS In addition to a competitive salary, employees also enjoy an attractive benefits package with the following elements: For your Health & Well-Being Medical and Dental HMO & PPO Plans Vision or Vision Reimbursement Basic and Supplemental Life Insurance Accidental Death and Dismemberment Insurance Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance Short and Long -Term Disability Insurance Voluntary Benefits - Accident Insurance, Critical Illness and Legal Services Employee Assistance Program For your Financial Future Retirement Plan - (Defined Benefit Pension Plan) Deferred Compensation Plan (457 Plan or Roth Plan) Annual Cost of Living Adjustments as determined by bargaining units May be eligible for Public Service Loan Forgiveness May be eligible for up to $3,300 in annual County allowance For your Work/Life Balance 12 paid holidays 4 Floating holidays and 7 Management Paid Leave days Vacation and sick leave accrual Vacation purchase program Catastrophic Sick Leave Employee Mortgage Loan Program Group Auto/Home Insurance Pet Insurance Commuter Benefits Program Employee Wellness Program Employee Discount Program Child Care Resources *Benefit rates are dependent upon the management employee's represented or unrepresented classification. ****************************************
$140.1k-170.3k yearly 1d ago

Looking for a job?

Let Zippia find it for you.

Senior Compliance Coding Auditor (REMOTE)
Central Health 4.4
Austin, TX jobs
This position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD‐10 codes on an annual basis. Responsibilities Essential Duties: • Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical and/or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer/title/grant coding requirements. • Identify coding discrepancies and formulate suggestions for improvement. • Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. • Work with the Office of the CMO and provider leadership to identify and assist providers with coding. • Report findings and recommendations to Compliance Officer or designee, management, and executive leadership. • Provide continuing education to providers and ancillary staff on CDT, CPT, HCPCS, and ICD-10 coding. • Support compliance policies with government (Medicare& Medicaid) and private payer regulations. • Perform research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines. • Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. • Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, and Billing to assist in accuracy of reported services and with chart reviews, as requested. • Work with the Purchasing department to order and distribute annual coding materials for all clinical sites and departments. • Assist Director of Compliance with incidents and investigations involving coding and/or documentation. • Work closely with all other Compliance personnel to provide coding/compliance support. • Advise Compliance Officer or designee of government coding and billing guidelines and regulatory updates. • Provide training to billing coding staff on coding compliance. • Participate in special projects and performs other duties as assigned. Knowledge/Skills/Abilities: • Proficiency in correct application of CPT, CDT, HCPCS procedure, and ICD‐10‐CM diagnosis codes used for coding and billing for medical claims. • Knowledge in correct application of SNOMED, SNODENT, and LOINC. • Knowledge of medical terminology, disease processes, and pharmacology. • Strong attention to detail and accuracy. • Excellent verbal, written, and communication skills. • Excellent organizational skills. • Ability to multi‐task. • Proficient in Microsoft Office Suite. • Critical thinking/problem solving. • Ability to provide data and recommend process improvement practices. Qualifications MINIMUM EDUCATION: High school diploma or equivalent. MINIMUM EXPERIENCE: 5 years of healthcare experience 4 years of procedural and diagnostic coding REQUIRED CERTIFICATIONS/LICENSURE: UPON HIRE AAPC Certified Professional Coder (CPC) certification OR Certified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA)
$62k-78k yearly est. Auto-Apply 60d+ ago
Compliance Auditor Senior - Healthcare Legal and Regulatory (Eastern United States resident)
Geisinger Medical Center 4.7
Remote
Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes The Senior Compliance Auditor ensures the integrity and accuracy of facility and professional compliance audits, monitoring, and provides compliance education for facility and professional documentation, coding, and billing. The Senior Compliance Auditor serves as a mentor for Compliance Auditors and assists management with the onboarding process for new Compliance Auditors. This position requires the use of judgement and critical thinking skills to determine appropriate corrective actions for non-compliance and ensure corrective actions are fully implemented by the entity service line area. Job Duties: One of the following coding or auditing certifications are required (CCS, CPC, RHIA, RHIT or CPMA). Performs scheduled facility and/or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD 10) and billing as required by the Compliance work plan reflecting scheduled activities and target dates. Performs audits resulting from unplanned investigations. Q/A work products of peers and serve as a mentor for compliance staff. Serves as primary lead for facility/professional billing compliance education, including auditing, trending, providing audit feedback to facility/professional coding staff and providers working in the hospital and office setting. Coordinates the development and implementation of corrective action and improvement plans with critical attention to performing a root cause analysis. Prepares responses to governmental audits, evaluate findings, and manage the appeals process. Assess compliance risk areas across Geisinger entities and assist with creating the Compliance Department's work plan. Performs research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines. Provides compliance guidance to Geisinger staff and serve as an institutional resource for Geisinger leadership, management and medical staff with a focus on federal payor billing compliance. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. #LI-REMOTE Position Details: Education: Associate's Degree-Related Field of Study (Required) Experience: Minimum of 7 years-Related work experience (Required) Certification(s) and License(s): Skills: Communication, Critical Thinking, Medical Billing and Coding, Organizing, Problem Solving, Training and Education OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
$58k-76k yearly est. Auto-Apply 60d+ ago
Compliance Coding Auditor
Sharp Healthcare 4.5
San Diego, CA jobs
**Facility:** System Services **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate; Other; Certified Health Care Compliance (CHC) - Compliance Certification Board **Hours** **:** **Shift Start Time:** Variable **Shift End Time:** Variable **AWS Hours Requirement:** 8/40 - 8 Hour Shift **Additional Shift Information:** **Weekend Requirements:** No Weekends **On-Call Required:** No **Hourly Pay Range (Minimum - Midpoint - Maximum):** $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. *This is a remote position* **What You Will Do** The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits. **Required Qualifications** + 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. **Preferred Qualifications** + Other : Strong background in in ICD-10-CM/PCS coding, DRG coding and CPT coding classification. + Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED + Certified Health Care Compliance (CHC) - Compliance Certification Board -PREFERRED **Other Qualification Requirements** + Bachelor's degree in Business, Healthcare Administration, or related field - required. In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered. + One of the following is required: AHIMA's Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification.Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire.Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. **Essential Functions** + Coding ComplianceCompliance Coding and Billing AuditsThe Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary.Reviews the electronic health record to identify potential coding and billing compliance issues. Prepares written reports of audits, including recommendations to improve compliance.The Auditor will analyze and assess Sharp's potential risks using SHC's billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc. + Policy and Procedure maintenance Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC's standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies. + Professional development Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program.Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education. + Unit support Key Stakeholder/Business Unit SupportResponsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries.Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding.Maintain professional relationship with key stakeholders focusing on high level of client satisfaction.Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians. + Professional competency Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. **Knowledge, Skills, and Abilities** + Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes. + Computer proficiency with Microsoft office applications is required. + Ability to function within a fast-paced, dynamic, and growing environment. + Excellent time management and problem solving skills. + Must demonstrate analytical ability, motivation, initiative, and resourcefulness. + Teamwork and flexibility required. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
$71.8 hourly 60d+ ago
Compliance Coding Auditor
Sharp Healthcare 4.5
Remote
Hours: Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. *This is a remote position* What You Will Do The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits. Required Qualifications 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. Preferred Qualifications Other : Strong background in in ICD-10-CM/PCS coding, DRG coding and CPT coding classification. Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED Certified Health Care Compliance (CHC) - Compliance Certification Board -PREFERRED Other Qualification Requirements Bachelor's degree in Business, Healthcare Administration, or related field - required. In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered. One of the following is required: AHIMA's Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification. Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Essential Functions Coding Compliance Compliance Coding and Billing Audits The Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary. Reviews the electronic health record to identify potential coding and billing compliance issues. Prepares written reports of audits, including recommendations to improve compliance. The Auditor will analyze and assess Sharp's potential risks using SHC's billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc. Policy and Procedure maintenance Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC's standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies. Professional development Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program. Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education. Unit support Key Stakeholder/Business Unit Support Responsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries. Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding. Maintain professional relationship with key stakeholders focusing on high level of client satisfaction. Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians. Professional competency Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Knowledge, Skills, and Abilities Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes. Computer proficiency with Microsoft office applications is required. Ability to function within a fast-paced, dynamic, and growing environment. Excellent time management and problem solving skills. Must demonstrate analytical ability, motivation, initiative, and resourcefulness. Teamwork and flexibility required. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
$71.8 hourly Auto-Apply 60d+ ago
Compliance Nurse Auditor
Baptist Memorial Health Care 4.7
Starkville, MS jobs
Job Summary Under the direction of Compliance Officer, within Department of Compliance Audit and Appeals, Nurse Auditor will be responsible for responding to external audits including writing appeals, working with Medical Staff and other staff. Nurse Auditor will be responsible for facility's communication and interactions with CMS, Recovery Audit Contractors (RAC) and other third party auditors. Nurse Auditor will document information and comments into the facilities tracking system to ensure audit deadlines are met. Nurse Auditor will work with other departments to gather information, conduct internal audits set forth in the OIG Work Plan and identify "problem areas" within the facility where changes to organizational practices, policies or procedures might be needed to enhance organizational efficiencies and effectiveness. Nurse Auditor, together with other members of the department, will prepare and monitor Corrective Action Plans, conduct education and training and monitor for progress toward improved performance and compliance. Other duties include conducting audits to identify problems and assisting the CFO as needed with Healthgrades, MACRA/MIPS, data collection, analysis and ultimately educating physicians for improvement. Qualifications:1. Bachelor's degree in nursing from an accredited program required. 2. Master's Degree in nursing, business or other health care related field preferred. 3. Current Mississippi Registered Nurse License. 4. Relevant Experience in a hospital setting. 5. Strong knowledge of state and federal law and regulations. 6. Understanding of CMS coverage and payment methodologies. 7. Excellent oral and written communication skills. 8. Advanced computer proficiency. 9. Excellent organizational skills and attention to detail. 10. Coding experience preferred. 11. Previous audit experience preferred. 12. Knowledge of InterQual and Principles of Managed Care preferred.
$55k-71k yearly est. 7d ago
Compliance Bill Auditor
Baptist Memorial Health Care 4.7
Starkville, MS jobs
Job Summary Under direction of Compliance Officer, Bill Auditor is responsible for bill auditing with overall goal of ensuring charges were billed and paid accurately. Bill Auditor examines medical records, billing information, payment histories, medical processes and regulations to identify inaccuracies, compliance issues and inefficiencies. Bill Auditor is responsible for responding to requests from Medicare, government entities and third party auditors and initiating either appeals or paybacks based on relevant regulations and guidelines. Bill Auditor works with other departments to gather information, conduct internal audits set forth in OIG Work Plan and identifies "problem areas" within the facility. Bill Auditor, together with other members of the department, prepares Corrective Action Plans, conducts education and training and monitors for progress toward improved performance and compliance. Other duties include entering information and comments to tracking system and HMS to ensure responses to audit requests are communicated to other departments and occur within required timeframe, monitoring impact of audits on facility's resources and conducting focus audits to identify areas where change to organizational practices, policies or procedures might be needed to enhance organizational efficiencies and effectiveness. Physical DemandsNote: "Occasionally" = 1% to 33% of the workday; "Frequently" = 34% to 66%; "Continuously" = 67% to 100%. This may also be described as performance once every 3 minutes = "Occasionally"; once every 1 ½ minutes to 3 minutes = "Frequently"; once every 1 ½ minutes to continuous work = "Continuously". 1. Standing/Walking - Occasional2. Sitting - Frequent3. Bending - Occasional4. Climbing/Reaching - Occasional5. Push/Pull - Occasional6. Handling/Lifting - Occasional7. Manual Dexteritya. HANDS - Simple grasp - Continuous; Firm grasp - Occasional; Fine manipulation - Occasionalb. FEET - Continuous8. Speaking/Hearing/Seeinga. SPEAKING - Able to communicate verbally with co-workers, patients, and visitorsb. HEARING - Functional with or without correctionc. SEEING - Functional with or without correction Qualifications 1. Bachelor's Degree. 2. Experience working in a hospital setting with billing auditing. 3. Knowledge and understanding of healthcare laws and regulations, CMS coverage and payment methodologies, coding and billing, and audit practices. 4. Computer skills and applications required for audits and research.
$55k-71k yearly est. 7d ago
Lead, Quality & Regulatory Compliance Auditor (Mentor, OH, US, 44060)
Steris Corporation 4.5
Mentor, OH jobs
At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. The mission of the STERIS Quality & Regulatory Compliance function is to implement repeatable and sustainable processes to ensure on-going compliance with domestic and international regulations and standards. This includes evaluating the relevance to all STERIS facilities and products and implementing efficient and effective processes to ensure adherence to applicable regulations and standards. * This is a hybrid role based in STERIS' Corporate Offices in Mentor, Ohio. In order to support the business needs working a minimum of 3 days a week in the Mentor office is expected. * 20% domestic and international travel required What you'll do as an Lead, Quality & Regulatory Compliance Auditor * Lead internal quality audits to assess compliance of a facility's quality management system with applicable US and international standards, regulatory requirements, and Corporate and local procedures, policies, and work instructions. Conduct internal audits using good time management practices to maximize efficiency. * Draft internal audit reports to clearly communicate audit findings and recommendations for compliance improvements. * Address and resolve any differences in viewpoints in a positive manner with a focus on continuous improvement and business efficiency while maintaining compliance. * Train developing auditors to support the internal quality auditing activity. * Support execution of the supplier quality audit program, including, qualifications and/or audits, routine monitoring, assessment meetings, action requests, and as necessary, issue resolution. * Provide support to the Quality & Regulatory Compliance team in the investigation and resolution of audit observations * Review corrective action activities for audit observations and obtain and review objective evidence as actions * are completed in accordance with prescribed commitments. * Lead and support the Quality Operations team in supporting key objectives, trending, and process * improvement. The Experience, Skills and Abilities Needed Required: * Four (4) year degree required, preferably with general business core, risk management, project management, regulatory, or internal audit * Minimum of four (4) years professional experience, preferably including regulatory affairs, legal, governmental compliance, quality systems, or internal auditing. * 25% travel required (domestic & international). Preferred: * Leadership / people management experience preferred. * Experience in the medical device industry is a plus. * Professional certifications and regulatory training certificates in relevant disciplines are desirable, as is completion of or actively working towards an advanced degree in a relevant discipline. * Bilingual skills are a plus, but not required. Skills: * Provide support to Quality & Regulatory Compliance department management as requested during the development of Senior Management and Compliance Committee presentation materials or special projects. * Conduct yourself in accordance with the principles of the STERIS Code of Business Conduct and comply with all Company policies. * Protect company confidential information by properly storing, retrieving, and disseminating such information only to those authorized. * Conduct daily activities of job responsibilities and projects as assigned. * Support a safe, clean, and secure working environment by supporting procedures, rules, and regulations. * Demonstrated experience in effectively leading quality audits. * Demonstrated ability to balance multiple high priority responsibilities on-time and effectively. * Self-starter with demonstrated organizational, project management, time management, and problem-solving skills. * Can comfortably and effectively confront difficult situations and issues in a timely and appropriate manner. * Strong interpersonal skills - ability to work closely with people at all levels within the STERIS organization and facilitate the implementation of corrective actions; able to work effectively and professionally with external people including suppliers. * Strong oral and written communication skills. * Excellent PC skills, including Microsoft Office applications, and the use of AI tools. Additionally, the Lead, Quality and Regulatory Compliance Auditor must have expert working knowledge of the following regulations and standards: * 21 CFR Part 820 -Quality Management System Regulations (QMSR) * 21 CFR Part 803 - Medical Device Reporting * 21 CFR Part 806 - Reports of Corrections and Removals * 21 CFR Part 7 - Enforcement Policy, Subpart C - Recalls * 21 CFR Part 211 - Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) * 21 CFR Part 11 - Electronic Records, Electronic Signatures * ISO 13485 Medical devices - Quality management systems * ISO 9001 Quality management systems - Requirements * EN ISO 11135-1 Sterilization of healthcare products - Ethylene Oxide * EN ISO 11137-1 Sterilization of healthcare products - Radiation * ISO/IEC 17025 General requirements for the competence of testing and calibration laboratories * ISO 14971 Application of Risk Management to Medical Devices * EU Medical Device Directive * EU Medical Device Regulation The compliance activities require close work with STERIS corporate domestic and international staff and Customers and U.S and foreign government agencies. What STERIS Offers We value our employees and are committed to providing a comprehensive benefits package that supports your health, well-being and financial future. Here is a brief overview of what we offer: * Market Competitive Pay * Extensive Paid Time Off and (9) added Holidays * Excellent Healthcare, Dental and Vision Benefits * Long/Short Term Disability Coverage * 401(k) with a company match * Maternity and Paternity Leave * Additional add-on benefits/discounts for programs such as Pet Insurance * Tuition Reimbursement and continued education programs * Excellent opportunities for advancement in a stable long-term care #LI-SA2 #ZRSA-1 #LI-Hybrid Pay range for this opportunity is $78,200.00 - $95,000. This position is eligible for bonus participation. Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc. STERIS offers a comprehensive and competitive benefits portfolio. Click here for a complete list of benefits: STERIS Benefits Open until position is filled. STERIS is a leading global provider of products and services that support patient care with an emphasis on infection prevention. WE HELP OUR CUSTOMERS CREATE A HEALTHIER AND SAFER WORLD by providing innovative healthcare and life sciences products and services around the globe. For more information, visit *************** If you need assistance completing the application process, please call ****************. This contact information is for accommodation inquiries only and cannot be used to check application status. STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity. The full affirmative action program, absent the data metrics required by § 60-741.44(k), shall be available to all employees and applicants for employment for inspection upon request. The program may be obtained at your location's HR Office during normal business hours.
$78.2k-95k yearly 43d ago
Lead, Quality & Regulatory Compliance Auditor
Steris 4.5
Ohio jobs
At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. The mission of the STERIS Quality & Regulatory Compliance function is to implement repeatable and sustainable processes to ensure on-going compliance with domestic and international regulations and standards. This includes evaluating the relevance to all STERIS facilities and products and implementing efficient and effective processes to ensure adherence to applicable regulations and standards. This is a hybrid role based in STERIS' Corporate Offices in Mentor, Ohio. In order to support the business needs working a minimum of 3 days a week in the Mentor office is expected. 20% domestic and international travel required What you'll do as an Lead, Quality & Regulatory Compliance Auditor Lead internal quality audits to assess compliance of a facility's quality management system with applicable US and international standards, regulatory requirements, and Corporate and local procedures, policies, and work instructions. Conduct internal audits using good time management practices to maximize efficiency. Draft internal audit reports to clearly communicate audit findings and recommendations for compliance improvements. Address and resolve any differences in viewpoints in a positive manner with a focus on continuous improvement and business efficiency while maintaining compliance. Train developing auditors to support the internal quality auditing activity. Support execution of the supplier quality audit program, including, qualifications and/or audits, routine monitoring, assessment meetings, action requests, and as necessary, issue resolution. Provide support to the Quality & Regulatory Compliance team in the investigation and resolution of audit observations Review corrective action activities for audit observations and obtain and review objective evidence as actions are completed in accordance with prescribed commitments. Lead and support the Quality Operations team in supporting key objectives, trending, and process improvement. The Experience, Skills and Abilities Needed Required: Four (4) year degree required, preferably with general business core, risk management, project management, regulatory, or internal audit Minimum of four (4) years professional experience, preferably including regulatory affairs, legal, governmental compliance, quality systems, or internal auditing. 25% travel required (domestic & international). Preferred: Leadership / people management experience preferred. Experience in the medical device industry is a plus. Professional certifications and regulatory training certificates in relevant disciplines are desirable, as is completion of or actively working towards an advanced degree in a relevant discipline. Bilingual skills are a plus, but not required. Skills: Provide support to Quality & Regulatory Compliance department management as requested during the development of Senior Management and Compliance Committee presentation materials or special projects. Conduct yourself in accordance with the principles of the STERIS Code of Business Conduct and comply with all Company policies. Protect company confidential information by properly storing, retrieving, and disseminating such information only to those authorized. Conduct daily activities of job responsibilities and projects as assigned. Support a safe, clean, and secure working environment by supporting procedures, rules, and regulations. Demonstrated experience in effectively leading quality audits. Demonstrated ability to balance multiple high priority responsibilities on-time and effectively. Self-starter with demonstrated organizational, project management, time management, and problem-solving skills. Can comfortably and effectively confront difficult situations and issues in a timely and appropriate manner. Strong interpersonal skills - ability to work closely with people at all levels within the STERIS organization and facilitate the implementation of corrective actions; able to work effectively and professionally with external people including suppliers. Strong oral and written communication skills. Excellent PC skills, including Microsoft Office applications, and the use of AI tools. Additionally, the Lead, Quality and Regulatory Compliance Auditor must have expert working knowledge of the following regulations and standards: 21 CFR Part 820 -Quality Management System Regulations (QMSR) 21 CFR Part 803 - Medical Device Reporting 21 CFR Part 806 - Reports of Corrections and Removals 21 CFR Part 7 - Enforcement Policy, Subpart C - Recalls 21 CFR Part 211 - Current Good Manufacturing Practice for Finished Pharmaceuticals (cGMP) 21 CFR Part 11 - Electronic Records, Electronic Signatures ISO 13485 Medical devices - Quality management systems ISO 9001 Quality management systems - Requirements EN ISO 11135-1 Sterilization of healthcare products - Ethylene Oxide EN ISO 11137-1 Sterilization of healthcare products - Radiation ISO/IEC 17025 General requirements for the competence of testing and calibration laboratories ISO 14971 Application of Risk Management to Medical Devices EU Medical Device Directive EU Medical Device Regulation The compliance activities require close work with STERIS corporate domestic and international staff and Customers and U.S and foreign government agencies. What STERIS Offers We value our employees and are committed to providing a comprehensive benefits package that supports your health, well-being and financial future. Here is a brief overview of what we offer: Market Competitive Pay Extensive Paid Time Off and (9) added Holidays Excellent Healthcare, Dental and Vision Benefits Long/Short Term Disability Coverage 401(k) with a company match Maternity and Paternity Leave Additional add-on benefits/discounts for programs such as Pet Insurance Tuition Reimbursement and continued education programs Excellent opportunities for advancement in a stable long-term care #LI-SA2 #ZRSA-1 #LI-Hybrid Pay range for this opportunity is $78,200.00 - $95,000. This position is eligible for bonus participation. Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc. STERIS offers a comprehensive and competitive benefits portfolio. Click here for a complete list of benefits: STERIS Benefits Open until position is filled. STERIS is a leading global provider of products and services that support patient care with an emphasis on infection prevention. WE HELP OUR CUSTOMERS CREATE A HEALTHIER AND SAFER WORLD by providing innovative healthcare and life sciences products and services around the globe. For more information, visit *************** If you need assistance completing the application process, please call ****************. This contact information is for accommodation inquiries only and cannot be used to check application status. STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity. The full affirmative action program, absent the data metrics required by § 60-741.44(k), shall be available to all employees and applicants for employment for inspection upon request. The program may be obtained at your location's HR Office during normal business hours.
$78.2k-95k yearly 38d ago
Compliance Auditor Prof Svcs - Remote
Cooper University Hospital 4.6
Camden, NJ jobs
About Us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development. Discover why Cooper University Health Care is the employer of choice in South Jersey. Short Description The auditor reviews professional fee billing, coding and documentation. Reviews to be performed are identified based on the then-current OIG Workplan and compliance risk analyses. Customers include employed providers, senior leadership, clinical and non-clinical staff of Cooper University Health Care. Under the supervision of the Chief Compliance Officer, auditors are responsible for supporting the corporate compliance program, responsibilities include: Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures Preparatory work for reviews/audits including developing a scope of work. Reviewing available documentation. Analyze/review audit data and prepare reports for review and presentation to management, providers and departments, making recommendations for improvement Determine charge corrections and refunds resulting from compliance reviews and ensure they have been completed. Post-review/audit education/training when applicable. Performing follow-up reviews when necessary. Ensuring appropriate work papers, either paper or electronic, are maintained in accordance with regulations/policy Assist in the development of policies and procedures that establish standards for compliance, as well as preparation of other guidance documents and tools to assist Coper providers and staff in appropriate billing, coding and documentation. Serve as liaison for questions, concerns, incidents and complaints regarding compliance matters, responding directly to the inquiry and/or consulting or interacting with other team members or departments. Inform Chief Compliance Officer of major findings; based on types of questions/concerns received, recommend remedial correction and prevention actions; identify education/awareness opportunities and guidance topics Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes Experience Required 3+ years' experience in an academic medical center preferred, with emphasis on provider compliance activities, including but not limited to: auditing, monitoring, investigation and training Demonstrated knowledge and understanding of provider professional fee billing, coding and documentation practices in inpatient and outpatient settings. Demonstrated expertise in medical terminology. Demonstrated expertise in healthcare coding (CPT, ICD-9, ICD-10, APC, HCPCS). Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information (PHI). Demonstrated knowledge and understanding of federal and state statutes, laws, rules and regulations affecting billing, coding and documentation practices in support of healthcare services provided to beneficiaries of federally-funded healthcare programs and other third party payers. Demonstrated knowledge and understanding of the essential elements of an effective compliance program Working knowledge and understanding of: - provider professional fee revenue cycle and reimbursement. - electronic billing and medical record systems - sampling technologies and statistical analyses .Experience using personal computers required. Experience using the following applications is desirable: Word, Excel, e-mail, and healthcare related billing systems. Experience using MDAudit audit software and/or EPIC EMR desirable Education Requirements Current certification as a CPC or COC License/Certification Requirements Current CPC or COC Valid driver's license and automobile insurance per company policy Salary Min ($) USD $36.00 Salary Max ($) USD $59.00
$66k-90k yearly est. Auto-Apply 30d ago
RESEARCH COMPLIANCE QUALITY AUDITOR II
Moffitt Cancer Center 4.9
Tampa, FL jobs
At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America's Best Large Employers and America's Best Employers for Women, Computerworld magazine's list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time's Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999. Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision. Summary Position Highlights The Research Compliance Quality Auditor II leads and conducts complex audits of clinical research studies to ensure adherence to federal and state regulations, International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) requirements, institutional policies and procedures, and organizational quality benchmarks. The Research Compliance Quality Auditor II may also be required to: 1. Identify and assess research compliance risks. 2. Investigate special or complex allegations of research/clinical trial noncompliance. 3. Provide expert recommendations for corrective and preventive actions. 4. Develop and deliver compliance education and contribute to policy development. 5. Prepare detailed reports on audit findings and compliance trends for the Research Compliance Officer/Program Manager. The Ideal Candidate: * The ideal candidate will have experience in a research quality and/or auditing environment with expertise, knowledge, and GCP experience in auditing clinical trials, including auditing internal processes, performing sponsor audits and proficiency with electronic systems used to manage clinical trial data or safety reporting. Oncology and/or hematology research experience preferred. * The ideal candidate will have LPN/RN license. Responsibilities: * Prepares, schedules, and conducts audits of investigator-initiated trials (IITs) and pharmaceutical sponsored trials to ensure compliance with applicable federal and state regulations, Good Clinical Practice (GCP) guidelines, and organizational quality standards. * Coordinates and manages corrective and preventive action (CAPA) plans to address audit findings and ensure timely resolution of compliance issues. Oversees audit-related correspondence and documentation, including memos and follow-up communications. * Prepares comprehensive written reports summarizing audit findings and recommendations, and presents results to department administrators, management, and other stakeholders as needed. Evaluates the effectiveness of corrective actions implemented by management to address identified deficiencies. Maintains accurate and organized audit records in accordance with institutional and regulatory requirements. * Develops research compliance training materials and delivers one-on-one and group training sessions to research and compliance staff. Ensures staff understanding and adherence to federal and state regulations, Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) regulations, and other applicable external agency standards, as well as internal research policies and procedures. * Maintains advanced knowledge of federal and state regulations, industry standards, and organizational policies governing clinical research, including Good Clinical Practice (GCP) guidelines, U.S. Food and Drug Administration (FDA) requirements, Centers for Medicare & Medicaid Services (CMS) standards, and other applicable agency regulations. Actively engages in professional development through participation in industry trainings, workshops, conferences, and expert discussion forums to ensure compliance expertise remains current and applicable to institutional needs. * Supports other QA projects as needed. Credentials and Experience: * Bachelor's Degree required - Field of study: Health Science, Regulatory Affairs, Research/Health Administration, Public Health, Clinical Research, Biomedical Sciences. * In lieu of a Bachelor's degree, an Associate's degree plus three (3) years of experience in a research quality and/or auditing environment. Experience in leading research auditing or monitoring is preferred. * Licensed Practical Nurse (LPN) or Registered Nurse (RN) required - In lieu of an LPN or RN license, two (2) years of Good Clinical Practice (GCP) auditing experience and a current Certified Clinical Research Professional (CCRP) certification may be considered. * Minimum of four (4) years of experience in a research quality, regulatory, and/or auditing environment, with demonstrated expertise in Good Clinical Practice (GCP) auditing of clinical trials. Experience should include auditing internal processes, performing sponsor audits, and proficiency with electronic systems used for clinical trial data management and safety reporting. * Comprehensive knowledge of International Council for Harmonisation (ICH) Guidelines, Good Clinical Practice (GCP) standards, U.S. Food and Drug Administration (FDA) Code of Federal Regulations, and other applicable laws and regulations governing clinical trials, including pharmaceutical and medical device requirements. * Proven ability to independently audit databases, trial master files, investigator sites, statistical and clinical study reports, and related processes and systems. * Skilled in conducting for-cause audits and computer system validation audits. * Ability to accurately interpret research protocols and audit medical records for compliance. * Advanced verbal and written communication skills for preparing reports and interacting with stakeholders. * Strong organizational, problem-solving, critical thinking, and decision-making abilities. * Ability to work independently or collaboratively on multiple projects with minimal supervision. * Experience in developing and delivering educational programs and workshops on research compliance. * Skilled in investigative methods, data analysis, and negotiation techniques. * Capable of managing and assigning Corrective and Preventive Action (CAPA) plans effectively. * Adaptable in applying investigative approaches for directed and for-cause audits. * Highly detail-oriented, accurate, and pragmatic in problem-solving with strong risk assessment capabilities. Share:
$52k-67k yearly est. 54d ago
COMPLIANCE AUDITOR
Moffitt Cancer Center 4.9
Tampa, FL jobs
At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America's Best Large Employers and America's Best Employers for Women, Computerworld magazine's list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time's Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999. Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision. Summary Position Highlights: * Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors. The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, and federal and state regulations and guidelines. * The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff and provides physician and coder education. * The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs and will serve as an institutional subject matter expert and authoritative resource. The Ideal Candidate Will Have The: * Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties. * Ability to work in both independent contributor and team roles (both as a team leader and team member) * Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership. Responsibilities: * Plans and performs scheduled and unscheduled professional or hospital compliance department audits, including accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews. * Evaluates the appropriateness of services and procedures billed based on supporting documentation. * Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. * Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices. * Develops compliance training content and provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others. * Conducts compliance orientation training for new providers. * Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations. Serves as institutional subject matter expert and authoritative resource in these areas. Credentials and Qualifications: * Bachelor's degree in Health Information Management, Business or related field. * Three (3) years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work. * In lieu of a bachelor's degree, HS Diploma/GED and seven (7) years of relevant experience will be considered. * Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.). * Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing. * Knowledge of Medicare and Medicaid documentation and coding rules and guidelines. * Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation. Preferred: * Professional and/or hospital services auditing experience in an Academic Medical Center. * Prior experience working in a Corporate Compliance environment. * Prior experience working in a Cancer Hospital. * Prior experience working in a Revenue Cycle Operations role. * Knowledge of Soarian and/or Soarian PRM applications. * Knowledge of Cerner Powerchart applications. Share:
$52k-67k yearly est. 49d ago
Compliance Auditor - SRS
Sharp Healthcare 4.5
San Diego, CA jobs
**Facility:** Copley Drive **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Professional Coder (CPC) - AAPC; Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA) **Hours** **:** **Shift Start Time:** Variable **Shift End Time:** Variable **AWS Hours Requirement:** 8/40 - 8 Hour Shift **Additional Shift Information:** Flex hours are 6:00-9:00 am to 14:30-17:30 pm **Weekend Requirements:** As Needed **On-Call Required:** No **Hourly Pay Range (Minimum - Midpoint - Maximum):** $34.170 - $44.090 - $49.370 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. **What You Will Do** To identify and report coding and documentation practices and make recommendations which assure the accurate reporting and documentation of services provided by entity clinical providers. To support and facilitate the implementation of correct coding standards by clinical providers as established by SHC Corporate Compliance in accordance to the CMS and local MAC (Medicare Administrative Contractor) requirements. **Required Qualifications** + 3 Years experience auditing coding and medical record documentation in an ambulatory care setting. + Experience developing training materials and presenting to a large group of professionals. + Certified Professional Coder (CPC) - AAPC **OR** Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA) -REQUIRED **Other Qualification Requirements** + Two years of college or five years working experience in a healthcare environment related to auditing of medical records and CMS compliance. - Required **Essential Functions** + AuditingParticipates in audit risk assessment for each division/provider to determine trends and helps management identify need for more frequent audits.Is able to analyze and create concise reports quantifying and summarizing audit findings. Presents the findings to Departments, Divisions, and at the Individual Provider level.Adheres to audit schedules and deadlines; prioritizes workload; communicates to management appropriately regarding workload and priority concerns.Utilizes internal and professional resource tools to provide quality audit results.Performs concurrent audits according to a defined audit schedule to assure that the documentation meets the standards set by CMS, local Medicare Administrative Contractor (MAC) and other third party payers.Performs provider quality audits to ensure provider is billing to meet established coding guidelines. + Client support Provider, Clinical, and Coding SupportServes as a resource providing support to SRS management, physicians, administrative and support staff for coding, documentation and compliance.Provides support with TES/CM edit resolution at assigned sites and assists with coding related edit questions.Provides professional and courteous support to providers, clinical staff, PFS, via email, phone and in-person contact, answering questions and providing supporting documentation for compliance standards. + Communication and training Effectively communicates audit results to supervisor, manager and/or director as appropriate.Provide timely feedback and final resolution of identified issues.Schedules and provides 1:1 training to provider to ensure maximum coding compliance guidelines are followed.Evaluates the inpatient and outpatient training and coding areas for improvement for assigned specialties and incorporates education specific to the needs of the specialty.Develops and maintains tools, guidelines and procedures to assist in provider's understanding of requirements for medical documentation and coding.Performs training for new providers with timely feedback on their documentation. + ComplianceHas a thorough understanding of ICD-10 and CPT coding guidelines.Protects all work products, working papers, personal lap top, and other related documents and/or portable electronic data systems in accordance with SHC and regulatory privacy and confidentiality guidelines.Stays current with Medicare updates and specialty specific professional services updates; communicates changes to management. + Data collection and reporting Designs and develops reports within a specified timeframe.Analyzes trends while reviewing documentation and communicates to management.Reports findings identified during documentation reviews and includes official references related to the findings. + EducationReviews coding publications for changes, clarifications and/or information pertinent to the medical group's specialties/services.Attends and participates in job related conferences, seminars and workshops to enhance skills and keep current on coding and documentation changes.Presents to management complete supporting documentation associated with areas of concern. **Knowledge, Skills, and Abilities** + Excellent working knowledge of CPT, ICD-10 and HCPCS codes is required. + Thorough understanding of Medicare, insurance documentation, and compliance and coding requirements. + Expert knowledge of MS Office which includes: Excel, Word, and PowerPoint. + Ability to educate and train all levels of clinical and professional staff. + Excellent interpersonal skills verbal and written, with the ability to communicate to all levels of staff within the organization. + Ability to produce high quality work/reports with minimal error rate. + Professional approach to work including ability to exercise mature judgement and maintain confidentiality in all activities. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class
$49.4 hourly 60d+ ago
Compliance Auditor 2-Physician
Loma Linda University Health 4.7
San Bernardino, CA jobs
Shared Services: Compliance- (Full-Time, Day Shift) - Job Summary: The Compliance Auditor-Physician monitors and audits established mechanisms and controls to ensure compliance with regulations. Audits the activities of various departments for compliance with plans, policies and procedures prescribed by management. Prepares and submits reports on the results of audits, recommending improvements in policies and procedures. Cooperates with outside auditors in any undertaking that may expedite their work. Performs other duties as needed. Conducts full range of physician-based audits/projects and develops partnerships with internal and external customers. Performs other duties as needed. Education and Experience: Bachelor's Degree required. Master's Degree preferred. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis. Knowledge and Skills: Experience with Physician-based audits/projects required. Able to read; write legibly; speak in English with professional quality; use computer and software programs necessary to the position, e.g., Word, Excel, Power Point, Access. Able to prepare and deliver verbal and written presentations. Knowledge of compliance issues related to CMS and OIG pronouncements. Highly functional and well-demonstrated process skills. Demonstrated flexibility in project and initiative management, able to complete work with constantly moving deadlines and multiple priorities. Excellent verbal, written, and interpersonal skills required. Demonstrates diplomacy, tact, a professional demeanor and an ability to relate to people of diverse demographic backgrounds. Ability to work independently. Committed to continuous quality improvement in systems, processes and performance; consistently exercises a learning attitude and approach to all duties; Work calmly and respond courteously when under pressure; team oriented. Able to avoid conflicts of interest and always maintain confidentiality. Able to demonstrate problem solving and reasoning skills. Able to analyze and synthesize data. Able to work independently and collaboratively with others. Able to maintain current knowledge of rapidly changing coding rules and changing Medicare and Medi-Cal regulations through independent research and continuing education. Able to handle pressure, deadlines and interruptions. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position. Licensures and Certifications: Minimum one of the following certifications required: CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician-based).
$55k-69k yearly est. Auto-Apply 60d+ ago
Senior Compliance Coding Auditor
Central Health 4.4
Austin, TX jobs
This position reports to the Director of Healthcare Compliance. Responsibilities include conducting billing and coding audits, and communicating results and recommendations to providers, management, and executive administration. This role will provide training and education to providers and ancillary staff. This position will support the implementation of changes to the CPT, HCPCS and ICD-10 codes on an annual basis. Responsibilities Essential Functions: Conduct prospective and retrospective chart reviews (i.e. baseline, routine periodic, monitoring, and focused) comparing medical record notes to reported CPT/HCPCS and ICD codes with consideration of applicable payer coding requirements. Identify coding discrepancies and formulate suggestions for improvement. Communicate audit results/findings to providers and/or ancillary staff and share improvement ideas. Work with medical staff department to identify and assist providers with coding. Report findings and recommendations to compliance and executive leadership. Provide continuing education to providers and ancillary staff on CPT/HCPCS and ICD-9/10 coding. Support compliance policies with government (Medicare & Medicaid) and private payer regulations. Work closely with all departments, including but not limited to, Clinical Services, Nursing, Practice Leadership, Finance, IT, Training, Rev Cycle, and Billing to assist in accuracy of reported services and with chart reviews, as requested. Work with the purchasing department to order and distribute annual coding materials for all clinical sites and departments. Advise Compliance Officer of government coding and billing guidelines and regulatory updates and work closely with department personnel to provide coding/compliance support. Participate in the development and enhancement of EHR templates and programming and advise on coding compliance with payor guidelines. Perform other duties as assigned. Knowledge, Skills and Abilities: Proficiency in correct application of CPT, HCPCS procedure and ICD-10-CM diagnosis codes used for coding and billing for medical claims. High Knowledge of medical terminology, disease processes and pharmacology. Strong attention to detail and accuracy. Excellent verbal, written and communication skills. Ability to multi-task. Excellent organizational skills. Proficient in Microsoft Office Suite. Critical thinking/problem solving. Ability to provide data and recommend process improvement practices. Qualifications Education: High School Diploma or equivalent (higher degree accepted) with 5 years of experience Associates Degree (higher degree accepted) Licenses/Certifications: Certified Professional Coder (CPC ) through AAPC OR Certified Coding Specialist (CCS ) through American Health Information Management Association (AHIMA) required. Required Work Experience: 5 years Experience in a medical office or medical environment. 5 years Experience in procedural and diagnostic coding. 5 years Extensive knowledge of current trends in the industry based on Medicare and Texas Medicaid as well as national coding updates, such as AMA correct coding, nationally recognized coding references and/or appropriate list serves. 5 years Extensive knowledge of Centers for Medicare & Medicaid (CMS) regulations.
$62k-78k yearly est. Auto-Apply 60d+ ago
Compliance Auditor
Marin Community Clinics 4.5
Novato, CA jobs
Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all. The Compliance Auditor supports Marin Community Clinics' compliance, risk management, and quality programs by performing independent audits, monitoring activities, and data validation to ensure adherence to federal and state regulations. This includes HRSA Health Center Program requirements, FTCA, CMS billing and documentation rules, Medi-Cal, TJC standards, HIPAA/HITECH, 42 CFR Part 2, California health laws, and internal policies. The role works closely with clinical, operational, billing, dental, behavioral health, specialty, and administrative teams to identify gaps, validate corrective actions, ensure MCC is audit ready, and ensure continuous improvement in compliance, quality, and patient safety. Responsibilities Compliance Auditing & Monitoring Conduct audits across medical, dental, behavioral health, specialty, and billing workflows. Evaluate documentation, coding, billing accuracy, and alignment with CMS, Medi-Cal, and HRSA requirements. Audit privacy/security compliance (HIPAA, HITECH, 42 CFR Part 2), telehealth consent, and minimum necessary requirements. Perform FTCA-related audits, including credentialing/privileging, QI, incident reporting, and OB risk processes. Review compliance with TJC standards and adherence to California laws and regulations. Regulatory & Policy Compliance Audit adherence to internal policies, workflows, and operational procedures. Incorporate regulatory updates (OIG, CMS, HRSA, and California) into audit tools. Support HRSA Site Visit Protocol (SVP) monitoring. Data Review & Reporting Develop audit tools and sampling methodologies. Produce clear audit reports outlining findings, trends, risk levels, and recommendations. Present results to leadership and committees; track corrective actions. Risk Identification & Mitigation Identify regulatory, financial, operational, and clinical risks and escalate issues appropriately. Recommend corrective action that support Just Culture and patient safety. Participate in root cause analysis (RCA) and after-action reviews. Training, Education & Technical Support Provide targeted feedback and education based on audit findings. Support development of compliance training modules and department workflows. Continuous Quality Improvement Validate quality measure documentation (UDS, HEDIS, CalAIM, dental and behavioral health metrics) and workflow adherence. Support performance improvement plans and monitor sustainability. Additional Duties Maintain audit logs, dashboards, CAP tracking, and trend reports. Support compliance hotline review, investigations, and regulatory survey preparation (HRSA, OSV, TJC, FTCA, CDPH, payer audits, etc). Participate in cross-functional meetings as needed. Additional duties as assigned. Supervisory Responsibilities: n/a Qualifications Education Bachelor's degree education in health-care administration, health information management or law is required. Master's degree level in related field is preferred. Relevant professional certifications a plus. Experience Minimum 2-4 years of experience in health-care compliance, coding/billing auditing, documentation review, or quality improvement. FQHC, ambulatory care setting, or multisite clinic environment strongly preferred. Working knowledge of Medi-Cal, CMS, HRSA, FTCA, and CA-specific health-care regulations. Certifications (Preferred) Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) Certified in Healthcare Compliance (CHC), or equivalent Dental coding certification a plus QI, risk management, or safety certification is a plus Required Skills and Abilities Strong understanding of HIPAA, HITECH, 42 CFR Part 2, CMS Billing Guidelines, Medi-Cal requirements, Cal/OSHA, and TJC standards. Coding knowledge (ICD-10, CPT, HCPCS, CDT, DSM-5). Excellent analytical, critical thinking, communication, and report-writing skills. Ability to manage multiple audits simultaneously. Ability to maintain confidentiality and professionalism at all times. Proficiency using EHRs (Epic, eCW, Dentrix, etc.), audit tools, spreadsheets, and dashboards. Physical Requirements and Working Conditions Fulfill Immunization and fit for duty regulatory requirements. Office and clinic-based; travel required between sites. Occasional evening / morning hours for audits or meetings. Ability to sit, stand, and walk for extended periods. Ability to lift up to 20 lbs. Benefits: Our benefits program is designed to protect your health, family and way of life. We offer a competitive Benefits Program that includes affordable health insurance and Health Reimbursement Accounts (HRA), Dental and Vision Insurance, Educational and Continuing Education Benefits, Student Loan Repayment and Loan Forgiveness, Retirement Plan, Group Life and AD&D Insurance, Short term and Long Term Disability benefits, Professional Fee Reimbursement, Mileage and Cell Phone Reimbursement, Scrubs Reimbursement, Loupes Reimbursement, Employee Assistance Programs, Paid Holidays, Personal Days of Celebration, Paid time off, and Extended Illness Benefits. Marin Community Clinics is an Equal Employment Opportunity Employer. Min USD $84,200.00/Yr. Max USD $95,000.00/Yr.
$84.2k-95k yearly Auto-Apply 47d ago
Compliance Program Auditor
Community Health of South Florida Inc. 4.1
Miami, FL jobs
The Assistant to the AVP of Risk Management and Compliance. Will be conducting independent and objective audits/reviews of departments and procedures to determine compliance with Federal and State regulations, specifically as it relates to Federal Healthcare Programs. POSITION REQUIREMENTS / QUALIFICATIONS: Education/Experience: Bachelor's Degree in Accounting, Finance or Business Administration. Three (3) years' experience in a Health Care Organization, preferably in a community health center. Licensure / Certification: Maintain current CPR certification from the American Heart Association. Skills / Ability: Fluency in English/Spanish. Demonstrates proficiency in communication and written skills. Position requires audit skills, preparation of reports to management and knowledge of Federal and State regulations which affect Healthcare. POSITION RESPONSIBILITIES (THIS IS AN EXEMPT POSITION) The incumbent serves at the pleasure of the President/CEO. Administrative duties in support of the Compliance Officer, whose duties are complex and broad in scope, in ensuring Community Health of South Florida, Inc. is in compliance with policies, procedures and regulation. Ability to use resources effectively and in recommending implementation of the types of internal controls that are preventive, detective and corrective in nature. Preparing worksheets to be utilized for audit/reviews as instructed by the Compliance Officer. Securing supporting documentation that substantiates audit/review findings. Researches regulations by reviewing regulatory bulletins and other sources of information. Monitors the Employee Reporting Hotline Preparing monthly reports and collecting necessary data. Conducts and participates in in-service training. Prepares reports by collecting, analyzing, and summarizing information. Works with the Compliance Officer to audit areas identified during risk assessments, items pertinent to the medical practice as identified by annual OIG work-plans, and other compliance and risk areas identified by the Compliance Officer. Performs on-going compliance audits utilizing as necessary, evaluation tools relating to audit; monitoring activities. Under the direction of the Compliance Officer identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit finds, including making recommendations for improvement and correction where identified. Under the direction of the Compliance Officer, performs risk assessments and determine the level of risk by: *Understanding laws and regulations *Obtaining and/or establishing policies for specific issues and areas *Educate on the policies and procedures and communicate awareness *Monitor compliance with laws, regulations, and policies *Audit the highest risk areas *Re-educate staff on regulations and issues identified in the audit Participate in Quality Assurance and Quality Improvement Programs and activities Performs other duties as assigned.
$52k-64k yearly est. Auto-Apply 38d ago
Internal Compliance Auditor
Indiana Donor Network 3.7
Indianapolis, IN jobs
Join Our Mission to Save and Enhance Lives Are you looking for a meaningful career where your skills and experience can make a life-saving difference? Do you want to contribute to a mission that leaves an incredible legacy? If so, Indiana Donor Network invites you to explore joining our team. Why Indiana Donor Network? Indiana Donor Network is a nationally recognized healthcare organization, serving as the crucial link between donors and patients awaiting life-saving organ transplants, healing tissue, and corneas that restore sight. As the state's federally designated organ recovery organization and an accredited tissue bank, we are dedicated to making a profound impact on countless lives. We are currently seeking an Internal Compliance Auditor to help fulfill our mission. About the Role The Internal Compliance Auditor is responsible for creating and maintaining all aspects of the internal audit function, vendor qualifications, and validations by identifying risks associated with various state, federal, and industry regulatory agencies in an effort to improve and sustain the organization's ability to further organ and tissue donation and transplantation. Provides advice and facilitation on the development of technical aspects of quality improvement efforts. Additional key responsibilities include: Performs scheduled, unannounced, and follow-up internal and external audits as scheduled and as necessary to evaluate the organization's performance as compared to internal and regulatory requirements. Communicates the purpose, necessity, and results of all internal audit programs to the appropriate stakeholders of the organization. Maintains vendor qualification program and performs surveys as scheduled and as necessary to evaluate an appropriate level of confidence that suppliers, vendors, and contractors are able to supply consistent quality of materials, components, and services in compliance with regulatory requirements. Documents internal audit and vendor qualification activities to contribute to the organization's quality program and to effectively evaluate performance of clinical and non-clinical operations. Oversees validation program to contribute to the organization's quality program and to effectively evaluate performance of equipment, supplies, and controlled documents. Actively participates as a liaison with the Indiana Donor Network leadership team. Completes special projects and/or assignments as directed in the areas of clinical data, quality systems, and/or clinical operations to support departmental quality improvement initiatives. Who We're Looking For A bachelor's degree in applied science or related field is required. A master's degree in business management is preferred. A minimum of five years' experience in auditing, including Lean Healthcare/Six Sigma training, and ASQ certification or equivalent is required. Medical experience or organ and/or tissue procurement/certification experience is preferred. Additional desired knowledge, skills and abilities include: Requires incumbent to be successful in working with all levels of Indiana Donor Network personnel. Basic knowledge of medical terminology and medications that relate to organ/tissue donation. Demonstrate proficiency in Microsoft Office, online databases and data entry, query, and reporting. Demonstrate organizational skills with ability to manage multiple tasks and set priorities. Demonstrate independent decision-making skills and ability to work autonomously. Skill in identifying and recommending improvements in policies, processes, and procedures. Skill in determining alternatives that would correct a situation to provide effective service to donor partners. Skill in maintaining composure and de-escalating emotionally charged situations. Skill in preparing written materials such as correspondence and reports to meet purpose and audience. Skill of receiving a message, understanding the intended message, and giving feedback to ensure expectations are met. Ability to establish and maintain positive and productive working relationships with vendors, coroners, funeral homes, regulatory agencies, etc. Ability to work cooperatively within a group to make the work of the group successful and effective. Ability to maintain open, clear, timely, and expected channels of communication, present ideas clearly and persuasively, and respond well to questions. Ability to maintain confidentiality of donor related records. Benefits & Perks At Indiana Donor Network, we believe in taking care of our team members. We offer: 100% employer paid health, dental, and vision insurance for our employees and dependents Annual health savings account contributions Paid pet insurance Annual bonuses for performance and retention Generous paid time off and holiday pay Professional development and growth opportunities A mission-driven, supportive work culture Join Our Life-Saving Mission If you are looking for a rewarding career where your work directly impacts lives, apply today and become part of our compassionate and dedicated team at Indiana Donor Network. Indiana Donor Network is an equal opportunity employer. Employment is contingent upon successfully passing drug screening and background check, including verification with the Social Security Administration, criminal records review, DMV check, and the Office of Inspector General.
$52k-71k yearly est. Auto-Apply 60d+ ago
Coding Compliance Auditor 2, Health Information Management, Full Time, Days
Jackson Health System 3.6
Miami, FL jobs
Department: Health Information Management Shift Details: Monday to Friday, Days. This is a remote position and is only open to candidates in Florida. Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century. Throughout its rich and storied history, Jackson Memorial - located in the heart of the City of Miami - has been ground zero for some of the world's greatest medical breakthroughs and important moments in South Florida. We've grown into one of the nation's largest public hospitals, and one of the few that is also a world-class academic medical center with a proud mission and proven success. Jackson Memorial is an accredited, tertiary teaching hospital with 1,500 licensed beds, where nearly every medical specialty is provided by some of the world's most skilled and highly regarded multidisciplinary team of healthcare professionals. Summary The HIM Coding/Compliance Auditor 2 analyzes abstracted, coded data for the purpose of ensuring coding accuracy. Serves as a resource for expert knowledge in coding and documentation requirements. Performs coding audits on inpatient and outpatients coders, reviews SMART edits, external coding audits, claim denials and audits from insurance companies, as well as, any other coding audits. Works very closely with the CDI Department. Must be an expert on ICD-9 and CPT Coding systems. Must have ICD-10 knowledge. Responsibilities * Performs Internal Coding Audits on inpatient and outpatient coders providing feedback and re-training as required. * Reviews findings from External Coding Audits for validity of DRG assignment and provide responses if there is a disagreement. * Discusses findings and any discrepancies in coding accuracy with external vendor, citing Coding Guidelines and coding Clinics. * Perform SMART edit reviews and educate the internal coders on their errors. * Review and respond to email requests from the CBO for DRG validation, missing procedure codes, Discharge Status discrepancies and Present on Admission assignments. * Provide responses to inquires from insurance companies regarding accuracy in codes used by the facility. * Reviews claim denials/audits from insurance companies. * Provide education and guidance to the CDI team and the inpatient and outpatient coding staff, reviewing diagnoses and/or procedures that require clarifications. * Annual coding updates are reviewed at these sessions, as well as, Coding Guidelines and Coding Clinics. * Works with the Rehabilitation Teams from Jackson Main and Jackson North reviewing and advising on concurrent coding worksheets. * Works with the CBO and the Revenue Cycle Team providing DRG validation and correcting accounts with missing or incorrect coding. * Provides feedback to the coder involved in each case. * entering coding for in-house patients as per CBO request. * Works closely with the CDI Team including concurrent DRG validation; provides assistance with assigning DRG's to in-house patients and provides individual guidance and education in applying Coding Guidelines. * Works with different services educating them on appropriate documentation to support the severity of the patient's condition. Neonatology Team, Burn Center, etc Experience * Generally requires 5 to 7 years of related experience. * Prior coding experience is highly preferred Education * High school diploma is required. * Bachelor's degree in related field is strongly preferred. Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.
$44k-54k yearly est. 28d ago
Compliance Nurse Auditor
Saint Francis Health System 4.8
New Haven, CT jobs
Current Saint Francis Employees - Please click HERE to login and apply. Full Time Days Job Summary: The Compliance Nurse Auditor assists with and supports the compliance program activities within Saint Francis Health System (SFHS). This role supports clinical coding and billing audit functions as well as the performance of routine and complex audits, oversight activities, and coordinates remediation and corrective action plans. Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 3 years of healthcare compliance clinical auditing experience within a hospital setting. Deep understanding of medical necessity, documentation standards, and clinical validation. Highly detail-oriented with strong critical-thinking and analytical skills. Ability to apply audit methodology consistently and defensibly. Comfortable reviewing large volumes of medical records and data. Collaborative approach with Compliance, Revenue Cycle, Case Management, Legal, and Operations Knowledge, Skills and Abilities: Strong knowledge of Centers for Medicare and Medicaid Services (CMS) guidance, regulations, policies, and direction from other government programs. Advanced proficiency within Microsoft 365. Ability to learn departmental and job-specific software programs. Excellent communication skills, both written and verbal that present clear and concise information. Superior ability to collect, analyze, and disseminate significant amounts of data with attention to detail and accuracy. Strong project management skills with the ability to manage multiple priorities simultaneously. Essential Functions and Responsibilities: Provides compliance program support with audits and monitoring, corrective action plan management, data analytics, and other projects to ensure proper execution of the compliance program work plan and priorities. Performs audits to ensure that the clinical documentation contained within the patient chart supports items and services included on claims and accurately supports reasons for treatment, billing, payment, and operations. Performs clinical review audits to validate compliance with regulatory requirements such as Emergency Medical Treatment Labor Act (EMTALA), Discharge Planning, and Quality. Provides independent evaluations and assists with the maintenance of operational controls, tools, policies, and procedures. Conducts regulatory research to identify gaps and provides interpretation of clinical requirements and regulations to ensure appropriate application of medical and clinical criteria. Remains abreast of current developments in compliance. Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field Working Relationships: Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above. Special Job Dimensions: None. Supplemental Information: This document generally describes the essential functions of the job, and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties. Corporate Compliance - Yale Campus Location: Tulsa, Oklahoma 74136 EOE Protected Veterans/Disability
$53k-66k yearly est. Auto-Apply 36d ago