Compliance Auditor jobs at Memorial Healthcare System - 155 jobs

**Our promise to you:** Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **All the benefits and perks you need for you and your family:** + Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance + Paid Time Off from Day One + 403-B Retirement Plan + 4 Weeks 100% Paid Parental Leave + Career Development + Whole Person Well-being Resources + Mental Health Resources and Support + Pet Benefits **Schedule:** Full time **Shift:** Day (United States of America) **Address:** 601 E ROLLINS ST **City:** ORLANDO **State:** Florida **Postal Code:** 32803 **Job Description:** **Schedule:** Full Time **Shift** : Days Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization's reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. **The expertise and experiences you'll need to succeed:** **QUALIFICATION REQUIREMENTS:** High School Grad or Equiv (Required), Technical/Vocational SchoolCertified Coding Specialist (CCS) - EV Accredited Issuing Body, Certified Professional Coder (CPC) - EV Accredited Issuing Body, Registered Health Information Administrator (RHIA) - EV Accredited Issuing Body, Registered Health Information Technician (RHIT) - EV Accredited Issuing Body **Pay Range:** $26.29 - $48.91 _This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances._ **Category:** Health Information Management **Organization:** AdventHealth Orlando Support **Schedule:** Full time **Shift:** Day **Req ID:** 150658628

Our promise to you: Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: * Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance * Paid Time Off from Day One * 403-B Retirement Plan * 4 Weeks 100% Paid Parental Leave * Career Development * Whole Person Well-being Resources * Mental Health Resources and Support * Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 601 E ROLLINS ST City: ORLANDO State: Florida Postal Code: 32803 Job Description: Schedule: Full Time Shift: Days Performs quality reviews on coded records to validate ICD-10, ICD-10-PCS, MS-DRG, APR-DRGs, and overall coding accuracy retrospectively and concurrently. Provides continuing education to individual coders and the coding staff concerning changes in the coding and reimbursement system and any weaknesses identified during the coding validation reviews. Reviews, analyzes, and interprets clinical documentation, seeking clarification from the physician when discrepancies exist, and effectively communicates with physicians and allied health personnel. Assists with writing compelling appeals to all DRG denials from outside agencies, referencing Official Coding Guidelines and Coding Clinic advice as appropriate to defend the DRG assignment and protect the organization's reimbursement. Serves as a resource to other departments in the Revenue Cycle to ensure business continuity and optimal revenue cycle management. Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance. The expertise and experiences you'll need to succeed: QUALIFICATION REQUIREMENTS: High School Grad or Equiv (Required), Technical/Vocational SchoolCertified Coding Specialist (CCS) - EV Accredited Issuing Body, Certified Professional Coder (CPC) - EV Accredited Issuing Body, Registered Health Information Administrator (RHIA) - EV Accredited Issuing Body, Registered Health Information Technician (RHIT) - EV Accredited Issuing Body Pay Range: $26.29 - $48.91 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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.

Align with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. We provide an outstanding benefit package that includes paid vacation, wellness initiatives and a 403(b). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals. What you be doing in this role: The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated with documentation, coding, and billing. This position is responsible for maintaining expert knowledge and understanding of coding and documentation guidelines. Collaboration with the Manager of Audit and Compliance and others where expertise in compliant coding and documentation is needed. In this role your duties will include: Performs physician compliance audits and group audits by analyzing medical record documentation and coding services to ensure compliance with government and organizational policies and procedures. Identifies areas of risk and/or non-compliance and provides recommendations for action - advances as needed. Conducts education and training sessions with individual providers on audit finding results, regulatory requirements and provide actionable feedback for improvement. Responsible for summarizing audits results and presenting to provider, operations leaders, other leadership. Communicates feedback directly to providers. Prepares necessary reports and communicates audit results to management and clinicians. Prepares training and education materials acting as subject matter expert. Tracks, records, and maintains audit/review activity in software or excel spreadsheets. Provides regular and ad hoc reporting. Assists with audit & compliance related special projects as requested. Maintains a high level of competency related to medical record documentation, coding and compliance with government regulations by attending appropriate workshops and seminars. Monitors Medicare and regulatory agencies rules for updates and changes and supports CSMN's core values and procedures. Acts as a professional liaison for physician compliance related activities, in a professional and confidential manner. Requirements: High school diploma or GED required. Bachelor's degree preferred. Certified Professional Coder certification required upon hire. A minimum of 2 years of professional fee coding/auding required, preferably in an academic medical setting. Why work here? We take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.

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

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 experience4 years of procedural and diagnostic coding REQUIRED CERTIFICATIONS/LICENSURE: UPON HIRE AAPC Certified Professional Coder (CPC) certification ORCertified Coding Specialist (CCS) certification through American Health Information Management Association (AHIMA)

The Healthcare Compliance Analyst & Examiner is responsible for ensuring organizational adherence to federal, state, and local healthcare regulations, as well as internal policies and procedures for the audit program. This role conducts audits, risk assessments, and data analysis to identify compliance vulnerabilities, develops and implements corrective action plans, and provides training and guidance to staff. Working with the VP, Chief Compliance officer will be responsible for the daily management of auditors; ensuring ongoing training, workplan completion and policy adherence. The Analyst collaborates with cross-functional teams-including legal, clinical, IT, and administrative departments-to foster a culture of compliance, accountability, and continuous improvement. Key Responsibilities Regulatory Compliance & Risk Management • Monitor and interpret changes in healthcare laws and regulations (e.g., CMS, Stark Law, Anti-Kickback Statute, ACA, state-specific requirements). • Develop, implement, and maintain compliance policies, procedures, for the audit program. • Conduct regular audits and reviews of medical records, billing, coding, provider activity, and departmental processes to ensure compliance with regulatory standards. • Perform risk assessments to identify areas of vulnerability and recommend corrective actions. • Investigate compliance billing-related incidents and ensuring proper documentation and reporting to authorities. • Responsible for the daily management of compliance auditors • Support responses to external audits and inspections. Data Analysis & Reporting • Analyze data to detect patterns, trends, and anomalies that may indicate compliance issues. • Prepare comprehensive reports on compliance activities, findings, and outcomes for management and regulatory bodies. • Maintain documentation of all compliance activities, methodologies, results, and corrective actions. Training & Education • Develop and deliver compliance training programs for employees at all levels. • Create educational materials and resources to support ongoing compliance education. • Stay current with industry best practices, regulatory updates, and emerging technologies (e.g., AI, data analytics platforms). Collaboration & Communication • Work closely with Compliance Officers, legal counsel, IT, clinical teams, and external partners. • Present findings and recommendations to senior management, committees, and other stakeholders. • Foster a culture of transparency, ethical conduct, and continuous improvement. Continuous Improvement & Technology • Integrate lessons learned from internal and external compliance issues into training and program development. • Leverage data analytics tools (e.g., Power BI, Tableau) and EHR systems (e.g., EPIC) to enhance compliance operations. • Monitor and test the effectiveness of compliance programs and technologies, ensuring alignment with organizational values and regulatory requirements. Qualifications • Certification in healthcare compliance (e.g., CHC, CHCP, CHRC, CPC, CPMA, CCS, RHIA, RHIT, LPN); Certified Fraud Examiner preferred. • Minimum 2-5 years of experience in healthcare compliance, auditing, or clinical management. • Strong knowledge of medical terminology, anatomy, coding guidelines (CPT, ICD-10/11, HCPCS), payer requirements, and reimbursement processes. • Experience with regulatory reporting, documentation, and compliance monitoring systems. • Advanced proficiency in Microsoft Office Suite; experience with data analytics platforms and EHR systems preferred. • Excellent analytical, organizational, and problem-solving skills. • Outstanding written and verbal communication skills; ability to present complex information clearly. • Ability to work independently and collaboratively in a team environment. • High level of discretion and confidentiality with sensitive information. Essential Functions • Conduct concurrent, prospective, and retrospective audits of medical records, and billing, provider activity. • Coordinate compliance-related audits, including governmental audits and appeals. • Communicate audit results and corrective actions to all relevant parties. • Research legislation, standards, and policies; provide analysis and recommendations. • Develop and manage audit workplans and strategies. • Maintain documentation and support training initiatives. • Coordinate with internal/external auditors and legal counsel. • Present audit findings to management and committees. • Maintain professional and technical job knowledge through ongoing education and participation in professional organizations. • Create and maintain KPI dashboards and compliance workplans. • Direct responsibility for completion of compliance audit workplan items.

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

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:

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. 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Broward Health Corporate ISC Shift: Shift 1 FTE: 1.000000 Conducts coding, billing, and documentation audits and investigations to evaluate the accuracy, compliance, and effectiveness of processes within physician practice operations. Creates reports outlining audit and investigation findings, including summaries of activities with recommendations for corrective action plans in alignment with department reporting guidelines. Develops and executes an audit program that ensures the performance of independent internal compliance audits focused on CPT, ICD-10-CM, and HCPCS coding accuracy, documentation integrity, and adherence to regulatory requirements. Education: * Bachelor Experience: 3 Years of Experience Credentials: Certified Coding Specialist, Certified Professional Coder, Certified Healthcare Compliance or must obtain within 18 months of hire. Visit us online at ********************* or contact Talent Acquisition * Bonus Exclusions may apply in accordance with policy HR-004-026 Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race, color, national origin, gender, gender identity or gender expression, pregnancy, sexual orientation, religion, age, disability, military status, genetic information or any other characteristic protected under applicable federal or state law. At Broward Health, the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.

Surgical Anesthesia Compliance AuditorCompliance Auditor MUST HAVE CPC CERTIFICATON - MUST be in the office located in Chappaqua, NY 3 days a week. - Chappaqua, NY- $100K-$115K Are you passionate about healthcare compliance and eager to make a meaningful impact? FlexStaff is seeking a detail-oriented and experienced Compliance Auditor to join our client's dynamic team! This hybrid position offers the perfect blend of in-office collaboration and remote work, all while contributing to an organization committed to excellence in patient care and regulatory adherence. In this pivotal role, you'll leverage your healthcare environment experience-whether as a Certified Professional Coder or similar professional-to audit and monitor clinical records, ensuring accuracy, completeness, and compliance. Your expertise with medical terminology, coding, and documentation will support our mission to uphold the highest standards of integrity and ethical practice. You'll conduct anesthesia chart reviews, identify billing and coding discrepancies, and communicate findings effectively to practitioners and teams. Responsibilities: **MUST HAVE ANESTHESIA BILLING AND CODING EXPERIENCE** - Support the Compliance Officer and the overall Compliance Program - Conduct anesthesia chart reviews to ensure records are complete, accurate, and support proper billing and coding - Audit anesthesia records focusing on quality, completeness, and correctness of claims based on services provided - Communicate review findings clearly and effectively to anesthesia practitioners and internal departments - Identify and address billing and coding gaps, including issues related to Time, Place of Service, Modifiers, CPT, and Diagnosis coding - Perform periodic probe audits to detect coding discrepancies that may lead to over- or under-billing - Document audit results and maintain reports; support educational efforts to improve compliance practices - Collaborate with internal departments and external auditors/consultants for billing and coding audits or consultations - Assist in addressing compliance concerns raised by staff through confidential mechanisms - Research documentation in ancillary systems to resolve overlapping times and billing issues - Support special requests for case logs, documentation, and records for anesthesia services as needed - Stay current on industry trends, regulatory updates, and best practices to ensure ongoing compliance - Serve as a backup to the Compliance Officer in their absence *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts,

This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded healthcare payors across the Baptist Physician Enterprise (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance related coding and billing questions and provide feedback on audit findings and necessary remediation/corrective action requirements. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards. Minimum Education Bachelor's Degree Health Information Management, Five years of related experience maybe considered in lieu of degree, Related field Required Minimum Work Experience 5 years Experience in a healthcare setting Required 1-3 years Healthcare coding and billing experience Preferred Prior experience with the following applications and systems: Healthicity, Altera Sunrise (formerly Allscripts), Hyland MRM, Clintegrity, FinThrive, and MS Office Suite and Excel in particular Preferred Performs routine and targeted audits of patient services and corresponding claims submitted to government payors. Audits outpatient (OP)/ambulatory service claims to assure a minimum of 95% accuracy and recommends corrective action, education, and training related to audit results. Audits the assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on sampled outpatient/ambulatory cases. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided. Utilizes Healthicity or other compliance and audit systems, develops and maintains comprehensive audit reports and documentation of each audit performed, cases sampled, and audit findings. Meets with audited providers/department leadership to present audit findings and required remediation/corrective actions to cure coding and billing errors; effectively educates and promotes awareness of compliant billing and coding requirements. Provides information to physicians and other health care staff regarding current coding practices and changes in state and federal regulations and guidelines. Researches and resolves problems referred by auditees and provides prompt feedback. Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and billing requirements. Participates in and provides education sessions as needed on specific coding topics at huddle meetings and other forums. Communicates with physicians and other health care staff to obtain missing information or to clarify existing information. Responsible for the identification of claims that require correction or other reimbursement related remedies to cure coding and billing errors identified through audit activities. Responsible for operational excellence; ensures the delivery of quality audit services in accordance with applicable policies, procedures, and professional standards.

The Internal Auditor II works in a self-directed team environment to execute internal audits as defined by management and the Audit Committee with progressive latitude for team goal setting, initiative and independent judgement on collective work products. The auditor works to identify and evaluate organizational risk, recommends and monitors mitigation action and supports the development of the annual audit plan. Essential Functions: Conduct operational, performance, financial and/or compliance audit project work including, business process survey, project planning, risk determination, test work, recommendation development and monitoring and validation of remediation Work within a self-directed team environment with limited direct supervision, employing significant creativity in determining efficient and effective ways to achieve audit objectives Actively participate in the development and implementation of a flexible risk-based, flexible annual audit plan considering control concerns identified by senior management Coordinate and collaborate on internal audit projects including assessing the adequacy of the control environment to achieve defined objectives in accordance with the approved audit program and professional standards Facilitate communication of organizational risks and audit results to business owners through written reports and oral presentations and provide support and guidance to organizational leadership on effective internal control design and risk mitigation Coordinate, monitor, and complete team tasks within agreed upon timeframes and meet individual and team project timelines, which may be aggressive at times. Influences team prioritization and scheduling of work, problem solving, assignment of tasks, and takes initiative when problems arise. Provides cross-training of team members Support management in onboarding new team members through mentorship, shadowing, and training of all required functions and processes and influence standards for expected team behaviors Assist in the coordination of external audits of CareSource by government agencies, accounting firms, etc. Develop and maintain productive professional relationships with CareSource staff and management by developing trust and credibility Significant interaction with others in the Department of differing skillsets (clinical, IT, etc.), organizational management and staff throughout CareSource, including interaction with the senior most levels Coordinate audit projects as necessary with other CareSource functions, including CareSource Assurance teams Generally conform to IIA standards and maintain all organizational and professional ethical standards, even in difficult or challenging situations Willing to accept feedback, coaching and criticism from others, including peers and management both in Internal Audit or outside of Internal Audit, reflect on the information, and adapt when appropriate Perform any other job duties as requested Education and Experience: Bachelor's degree in finance, business management, healthcare administration, accounting or related field or equivalent years of relevant work experience is required Master of Business Administration (MBA), or other graduate degree is preferred A minimum of three (3) years of finance, business management, healthcare administration, accounting or related field is required; experience in internal auditing or public accounting is preferred Knowledge of audit principles and IIA Standards and Code of Ethics required Experience in risk and control assessments is preferred Experience in thoroughly documenting process flows and controls in financial, and/or business operations cycles preferred Experience with Sarbanes Oxley 404 or Model Audit Rule preferred Experience in health care or insurance fields is preferred Competencies, Knowledge and Skills: Strong communication skills, including proper writing skills adaptable for the audience and purpose, presentation skills for internal or external audiences and senior management, and interpersonal skills sufficient to develop strong professional relationships with CareSource management and staff Solid critical thinking skills including professional skepticism and problem resolution Data analysis and trending skills and ability to compose and present reports using audit data Ability to work in a matrix environment with responsibility for multiple deliverables for multiple functional areas within CareSource Team and customer service oriented Collaborative mindset and ability to operate in a self-directed team environment with collective accountability Strong ability to adapt to changing environment Strong self-leadership, organizational and time management skills Driven to proactively seek relevant development, education and training opportunities Strong sense of integrity and ethics in performance of all duties Takes initiative to identify and influence innovative process improvement Self-driven to work independently within a team environment Success in working in a self-directed matrixed environment Advanced level experience in Microsoft products Licensure and Certification: CIA, CISA, CPA, CMA, CRMA or other appropriate finance, IT or internal audit licensure or certification is preferred Working Conditions: Most work will be performed in an office or virtual setting; however, performing onsite audits may also be necessary depending on assignments May be required to sit or stand for extended periods Compensation Range: $61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1

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.

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.

Definition: The Medicare Compliance Auditor reports to the Director of Clinical Education and, through auditing and monitoring activities, assists in ensuring compliance to state and federal laws, statutes, and regulations related to home health care services and billing processes within NHC HomeCare. Qualifications: Valid, unencumbered multi-state RN or LPN license with at least 5 years clinical experience; Minimum five (5) years' experience in Medicare-reimbursed home health care; Experience in auditing and analyzing clinical records; Deep working knowledge of the home health industry and of applicable state and federal laws, statutes and regulations, including reimbursement and compliance regulations; Demonstrated ability to engage, motivate, and train clinical and operations staff; Strong oral and written communication, interpersonal, and organizational skills; Strong analytical and critical thinking skills; Self-directed with ability to work effectively alone or as part of a collaborative team; Computer literacy to the extent required to competently perform job duties; Commitment to best practice patient care with optimum patient outcomes and satisfaction provided in compliance with regulations; Maintains current Driver's License, car insurance, and safe driving record; and Able to meet Background Screening requirements. Specific responsibilities: Serve as a subject matter expert with deep working knowledge of applicable laws, statutes and regulations; Serve as a knowledgeable resource regarding NHC policies and procedures; Perform detailed audits of documents, including medical records, to ensure compliance to government regulations. Related audits include but may not be limited to RCDs, ADRs, CERTs, RACs, ZPICs, TPE audits, and Reopening Process reviews; Compose professionally formatted letters submission to the government contractors; Submit records and appeals in a timely manner with accurate tracking and status reports; Prepare for and participate in Administrative Law Judge (ALJ) hearings; Initiate and track follow-up and resolution to investigations, document requests and audit findings with agency staff and Regional/corporate partners as needed; Maintain the confidentiality of protected health information and NHC business practices; Competently navigate the EMR system to access needed documents; Participate in conference calls, webinars, and on-site meetings/training as assigned or requested; Collaborate on developing and providing targeted teaching and training programs via appropriate instructional methods including instructor-led group trainings, on-line learning, videos/webinars, over-the-phone training, or workshops; Contribute to the development of written processes to ensure compliance. Perform other functions as required for position-related activities. Contributes to the achievement of company goals, by Assuring efficient and effective management of related human and material resources; Maintaining a strong working knowledge of federal and state Home Health regulations, company policies and procedures, professional clinical standards and evidence-based best practices; Organizing, prioritizing, and completing projects independently in a timely and goal-oriented manner; Contributing meaningfully to the success of the NHC HomeCare team; Supporting and contributing to Quality Assessment Performance Improvement (QAPI) activities as indicated; Modeling the company's ‘Better Way Promises' and Standards of Code of Conduct and Compliance; and Representing and promoting NHC HomeCare positively in the community.

The range for this role is $116,000 - $167,500 Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and able to work onsite full time in our Melbourne, FL office. The Mission At Christian Care Ministry we believe that Christians can, and should, share in one another's burdens. Through the use of Medi-Share , a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility. The Team Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren't perfect people, we are serving our perfect God and our Members to the best of our ability. The Job The Principal Internal Auditor reports to the Chairman of the Audit Committee (administratively to the Chief Risk Officer) and is responsible for the timely execution of risk-based internal audits in accordance with the annual internal audit plan, as well as assisting with other audit matters and projects, as directed by the Audit/Finance Committee. Coordinates, controls, develops, and administers Christian Care Ministry's internal audit program, system and procedures to determine the effectiveness of controls, accuracy of records, and efficiency of operations. Reviews company operations and financial systems and evaluates their efficiency, effectiveness, and compliance with internal corporate policies and procedures, and applicable external laws and government regulations. Essential Job Duties & Responsibilities Conduct risk assessments of ministry operations and departments Establish risk-based internal audit plan and work programs Determine scope of audits in consultation with Audit Committee Review and assess the suitability of internal control design Conduct audit testing of specified areas and identify reportable issues and dimensions of risk Perform inquiries and testing as needed to identify and resolve vulnerabilities Develop audit programs to ensure adequate financial controls Evaluate compliance with ministry policies and procedures Communicate audit findings to Senior Management and Audit Committee Prepare comprehensive audit reports for review with Senior Management and Audit Committee Contribute to the exercise and expression of CCM's Christian beliefs All other duties as assigned Essential Skills & Abilities Outstanding written/verbal communication skills and interpersonal/relationship building skills Strong data analytics experience and top-notch investigatory and research skills Extensive knowledge and familiarity with IT systems, tools, and IT general controls Thorough knowledge and understanding of AI (artificial intelligence) concepts and tools Advanced MS Excel/Word/PowerPoint skills Ability to adapt to change quickly and multi-task effectively Ability to read and interpret documents; author routine reports and correspondence; and speak effectively with members, providers, and/or associates of the organization Core Competencies/Demonstrable Behaviors Manages complexity - making sense of complex, high quantity and sometimes contradictory information to effectively solve problems Financial acumen - interpreting and applying understanding of key financial indicators to make better business decisions Drives Results - consistently achieves results, even under tough circumstances/ tight deadlines. Resourcefulness - securing and deploying resources effectively and efficiently Optimizes work processes - knowing the most effective and efficient processes to get things done, with a focus on continuous improvement Education and/or Experience Bachelor's degree in accounting or finance with 7-10 years' financial experience, through public accounting or industry that includes 5 years' external or internal auditing required Certified Public Accountant certification preferred Certified Internal Auditor certification preferred Supervisory Responsibilities This job has supervisory responsibilities: you will be expected to supervise a team of 1-2 employees Incentives & Benefits We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others. For full-time employees working 30 hours or more, some of our benefits include, but are not limited to: • 100% paid Medical for employees/99% for family • Generous employer Health Savings Account (HSA) contributions • Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance • 6 weeks of paid parental leave (for both mom and dad) • Dental - two plans to choose from • Vision • Short-term Disability • Accident, Critical Illness, Hospital Indemnity • 401(k) - up to 4% match on ROTH or Traditional contributions • Generous paid-time off and 11 paid holidays • Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo • Employee Assistance Program including no cost, in-person mental health visits and employee discounts • Monetary Anniversary Awards Program • Monetary Birthday Awards Minimum Age Requirement: Due to the nature of the responsibilities associated with this position-including independent decision-making, access to confidential information, and potential exposure to regulated environments-candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.

Full-time Description The Claims Recovery & Audit Specialist researches claims payments and pursues recoveries through contact with various parties and/or claim recoupments, as needed. The specialist manages all claims that require recovery for overpaid or incorrectly paid claims, coordination of benefits with other insurance companies, claims paid after termination, claims paid to wrong providers, duplicate payments, subrogation refunds and all other claims scenarios. May include initiating telephone calls to providers and other insurance companies to gather coordination of benefits data. Responsible for sending refund request letters to provider. Duties and Responsibilities · Investigate, resolve, and pursue recoveries on all types of claims. · Responsible for update refund check in core claims system · Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information. · Recover incorrectly processed claims through the claim's adjustment process. · Monitor and stay current with Plans benefits and policy language. · Deal with internal/external personnel in an effective professional manner; providing information requested and resolving problems that arise. · Able to work in a fast paced, varied environment and manage priorities while maintaining a positive, customer focused attitude. · Monitor and report pertinent issues and information to management for awareness, knowledge, and action. · Respond accurately, courteously, and quickly to phone and written correspondence related to contract, provider, client and insureds' inquiries or concerns with appropriate follow up as necessary. · Research and respond to audit requests from internal and external auditors and PNS providers quickly and efficiently. · Evaluate and make recommendations on training material and methodology. · Support the implementation of new procedures and/or operational changes to support Company vision and strategy. · Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance. Requirements Knowledge · Bachelor's degree in accountancy or commerce along with 3+ years of claims auditor experience Skills · Data management ability and knowledge in computer, including MS Excel and MS Words · Familiar with health insurance concepts, practices, and procedures · Knowledge of HCFA 1500 and UB04 billing forms, EOP as well as related data interpretation · Solid understanding of different provider payment methodologies Salary Description $56,000.00 - $58,000.00 per year