Compliance Auditor jobs at Providence Health & Services - 457 jobs

The Compliance RCM Auditor is responsible for reviewing and verifying that a healthcare provider's revenue cycle management (RCM) practices adhere to all relevant compliance regulations, including coding guidelines, billing procedures, and patient demographic data, by conducting audits to identify potential issues and ensure accurate billing and patient record keeping, while recommending corrective actions to maintain compliance with federal and state laws. The Compliance RCM Auditor works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions Summary of Essential Job Functions The key responsibilities of the Compliance RCM Auditor include but not limited to: Reviewing medical records: Analyzing patient charts to ensure proper diagnosis and procedure coding (CPT, ICD-10, HCPCS) accuracy against billing claims. Claims auditing: Assessing submitted claims for compliance with payer contracts, including verifying patient demographics, insurance eligibility, and billing codes. Data analysis: Utilizing data analytics tools to identify patterns of potential compliance issues, such as high denial rates or unusual coding trends. Contract compliance: Reviewing payer contracts to ensure accurate billing practices and appropriate reimbursement based on contract terms. Documentation review: Checking for complete and accurate documentation supporting medical necessity for billed services. Identifying areas for improvement: Reporting findings and providing recommendations to improve RCM processes and mitigate compliance risks. Investigating complaints: Reviewing potential compliance concerns raised by patients, payers, or internal stakeholders. Reporting and documentation: Preparing detailed audit reports with findings, corrective action plans, and supporting documentation. Responsible for complying with all federal, state and local regulatory agency requirements Responsible for complying with all accrediting agencies Qualifications Compliance Auditing experience required, preferred experience in behavioral health and/or substance abuse auditing Proven expertise in healthcare coding, preferably within mental and behavioral health, or substance abuse strongly preferred. Thorough understanding of medical coding systems (CPT, ICD-10, HCPCS) and their application in clinical practice. Deep familiarity with HIPAA, Medicare, Medicaid, and other relevant healthcare compliance laws Proven experience conducting RCM audits, including sample selection, data analysis, and report writing Ability to analyze complex data, identify trends, and draw accurate conclusions Certified Professional Coder (CPC) and/or Certified Professional Medical Auditor (CPMA) or CIA strongly preferred. If not certified, willing to pursue certification. Meticulous approach to reviewing medical records and billing data to ensure accuracy Effective communication with healthcare providers, billing staff, and management to discuss audit findings and recommendations The Compliance RCM Auditor must comply with federal and state regulations regarding certification, licensure, and degree. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

at BayMark Health Services Full Time - Compliance Manager BayMark Health Services is looking for a detail-oriented and conscientious Compliance Manager to provide auditing and regulatory oversight to programs under the direction of the Chief Clinical Compliance Officer. Responsibilities: Manage and maintain compliance with federal and state rules, regulations, laws and standards for BayMark clinic operations. Performs audits of clinical services, develops auditing tools, and serves as point of contact for auditors, and oversees compliance with corrective action plans. Maintains current knowledge of rules, regulations and disseminates regulatory and legislative updates. Partner with Chief Clinical Compliance Officer in the development and/or revision of policies and procedures on state and federal rules and regulations. Alert management to deficiencies or serious non-compliance issues that have potential for high risk. Assists as requested with compliance/policy and procedural development for new and acquired clinics. Participation in the company performance improvement process, partners with clinic directors to meet objectives, and provides management reporting Other duties, as assigned. Qualifications: Minimum 2 years' college. Bachelors or Master's degree preferred. Nursing or Counseling licensure/certification preferred; prior Compliance experience Experience with the survey process of a health care services operation including JCAHO, CARF, Medicare, and/or state licensing survey process. Understanding of clinic operations Understanding of HIPAA, Federal, State, CARF and/or JCAHO standards and regulations. Knowledge and skills of Microsoft products with strong proficiency with Excel. Excellent interpersonal and communication (both verbal and written skills.) Self-motivated with ability to work in an interdisciplinary setting. Ability to work with little supervision and demonstrated organizational skills. Satisfactory drug screen and criminal background check Ability to travel 50% - 70%. Benefits: Competitive salary Comprehensive benefits package including medical, dental, vision and 401(K) Generous paid time off accrual Excellent growth and development opportunities Satisfying and rewarding work striving to overcome the opioid epidemic Here is what you can expect from us: BayMark Health Services specializes in the treatment of opioid addiction. BayMark Health Services provides medication-assisted treatment services in a variety of modalities and settings through our divisions: BAART Community HealthCare, Health Care Resource Centers and MedMark Services, Inc. BayMark Health Services, also provides traditional primary health care services, as well as integrated primary care, in select locations. BayMark Health Services is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws.

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. ****************************************

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)

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.

**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

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Works independently performing program, compliance, and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions through an action plan. Responsible for coordinating, developing, and conducting educational training based on audit outcomes. Provides educational training to coders, billers, physicians, and others on documentation requirements and correct coding of inpatient, outpatient, and professional fee services. Applies substantial knowledge of the job and experience to complete a wide range of activities with varying difficulty. Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program. Job Requirements: Education and Work Experience: Associate's/Technical Degree or equivalent combination of education/related experience: Required Bachelor's Degree: Preferred Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services: Required Five years' experience in auditing in clinic and/or facility revenue cycle: Preferred Licenses/Certifications: Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-Phy) or Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT): Required Professional Medical Auditor (CPMA) or Certified E&M Coder (CEMC) or Certified E&M Auditor (CEMA) or Certified Documentation Integrity Practitioner (CDIP) or Certified Clinical Documentation Specialist- (CCDS) or CIRCC-AAPC or Radiation Oncology Certified Coder (ROCC): Preferred Essential Functions: Performs comprehensive reviews of health care records for accuracy of revenue cycle billing compliance to include but not limited to medical necessity, compliance risk, review of denials, charge trends, and applied CPT, HCPCS, ICD 10-CM and ICD-10-PCS coding guidelines for inpatient, outpatient, and/or clinic visit encounters that correlates to clinical documentation. Performs a variety of activities in support of internal audits and coordinates external audits including Recovery Auditor Contractors' (RAC), Livanta, Target Probe and Educate (TPE) and Attorney Client Privilege Audits. Produces comprehensive audit finding reports that include quantifiable impact, identify areas of opportunity for education, as well as improvement recommendations. Ensures timely dissemination of external audits; generates timely appeals and adheres to all deadlines. Generates RAC reports including but not limited to dollars at risk; Tracks and trends and provides education to coding, operations, and Physicians as needed. Communicates clearly (verbally and in written reports or summaries) opportunities regarding proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles. Leads and facilitates multi-disciplinary workgroups or projects. Ability to be a project lead to facilitate through all successful action outcomes. Mentors, coaches, and helps to provide on-job training for staff. Participates in improving the efficient and effective delivery of the Department's services including promoting the department brand, complying with department and professional standards, participating in department initiatives and internal process improvement projects, and providing input into the enhancement of audit methodologies, workflows and tools. Generates audits, utilizing Auditing platform for denials, coding reviews and other risk-based data for department audits. Reviews, researches, references state and federal regulations, payer program memorandum, and other complex, technical and/or legal documents. Participates in annual risk assessment and work plan development processes. Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit ******************************************** for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

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)

Pay Range: Pay Range:$47.69 - $67.19 Ensure SEARHC meets federal and state regulations and internal policies in regard to healthcare coding, documentation, and billing practices. Review health records to verify coding and clinical documentation meets applicable coding and billing requirements, Medicare/Medicaid regulations, federal and state laws, and SEARHC policy. SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement. Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more. Key Essential Functions and Accountabilities of the Job Conduct Audits: Review health record documentation, claims, coding, policies and processes to identify compliance or non-compliance with SEARHC policies, state and federal laws and regulation, Medicare/Medicaid regulations, and national coding standards. Analyze Data: Examine data to identify patterns and trends for compliance or non-compliance. Identify Risk: Analyze audit results, data, policies, and processes to assess risk. Develop Audit Plans: Create audits based on risk assessments, billing practices, new services, Medicare/Medicaid risk areas, Medicare/Medicaid audits, and RAC and PERM audits. Prepare Reports: Document audit findings and recommendations. Present reports to the Compliance Director, Chief Legal Officer, Division Vice President, Compliance Committee and Accreditation Governing Body. Training and Education: Prepare and provide training and education to staff in response to audit findings, and staff inquiries. Other Functions Assist the Compliance Director as needed. Work closely with legal counsel when interpretating billing laws and regulations Receive and investigate compliance and HIPAA complaints during absence of the Compliance Director. Education, Certifications, and Licenses Required Bachelor's or AA degree, preferably in health-related field preferred. College coursework in medical terminology, anatomy, and physiology. Certification as Professional Coder, Coding Specialist, Inpatient/Outpatient Coder. Experience Required Minimum of three years' compliance auditing or health records coding in a healthcare entity. Knowledge of Healthcare compliance, health care coding and billing process, medical coding classification (CPT, ICD, HCPCS) rules, Medicare/Medicaid documentation rules, State and Federal medical record requirements and guidelines. Medical terminology. Electronic health record systems Skills in Writing reports, preparing training and education presentations, effective communication, problem-solving, reading and interpretating laws and regulations. Ability to Audit health records for documentation, coding, and billing purposes; investigate compliance concerns; prepare written reports for audits; meet deadlines; understand compliance and regulatory issues; use effective training and communication skills; listen and understand; resolve conflict; analyze data; transform data into meaningful reports; work under pressure; multitask; and function independently. Travel Required Travel may be required to attend meetings, present educational sessions, and present audit findings. Travel is by jet, small aircraft, or ferry. Required Certifications: Certified Coding Associate - American Health Information Management Association If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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.

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.

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

The Compliance Auditor supports an effective compliance program by planning and executing risk-based audits, monitoring adherence to federal and state regulations, and evaluating internal controls and procedures. The role partners with departments across the organization to assess billing, coding, privacy/security, and operational practices; identifies vulnerabilities; and recommends corrective actions that promote ethical, compliant operations. The position prepares clear reports for leadership and supports survey readiness, investigations, and ongoing education to sustain compliance. Qualifications: Bachelor's degree in healthcare administration, business, accounting, or related field. Professional certification (e.g., Certified in Healthcare Compliance (CHC), Certified Professional Compliance Officer (CPCO)); or ability to obtain within twelve (12) months of hire. Three (3) years of experience in healthcare compliance, auditing, or a related field. Intermediate knowledge and experience reviewing clinical documentation, billing, and coding for compliance. Intermediate knowledge and experience with electronic health records (EHR) systems (preferably Epic) and compliance/audit management tools. Intermediate knowledge of CMS guidelines, payer requirements, HIPAA Privacy and Security Rules, and foundational healthcare regulations (e.g., Anti ‑ Kickback Statute, False Claims Act, EMTALA). Intermediate proficiency with Microsoft Excel and report preparation; familiarity with statistical sampling methods for audits. Preferred: Master's degree in healthcare administration, business, accounting, or related field. Certified Professional Coder (CPC) or similar coding credential. Prior experience supporting regulatory surveys/investigations and accreditation standards (e.g., Joint Commission, CMS Conditions of Participation). Experience in small to mid-size healthcare organizations and with quality improvement methodologies. Essential Job Functions: In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements. Develops and maintains a risk‑based annual audit plan aligned with organizational risks and OIG work plan priorities. Conducts audits of clinical documentation, billing, coding, and operational processes to evaluate compliance with applicable laws, regulations, payer rules, and internal policies. Reviews medical and billing records for coding accuracy and medical necessity; validates documentation sufficiency and identifies trends. Monitors adherence to HIPAA privacy and security requirements, including appropriate handling of PHI and breach prevention practices. Investigates reported compliance concerns and hotline allegations; documents findings, determines root causes, and recommends corrective actions. Prepares clear, concise audit reports and dashboards; presents results and risk‑based recommendations to leadership and stakeholders. Tracks and validates completion of corrective action plans (CAPs) to ensure timely and sustained remediation. Supports preparation for and response to regulatory surveys, inquiries, and external audits; coordinates evidence collection and responses. Maintains compliance data repositories, audit workpapers, and tracking systems with accurate, timely documentation. Collaborates with departmental leaders to prioritize work, coordinate information requests, and minimize operational disruption during reviews. Assists in developing and delivering compliance education for leaders, providers, and staff; supports onboarding and orientation activities. Stays current on changes in healthcare regulations and payer policies; communicates impacts and updates procedures accordingly. Knowledge, Skills and Abilities Demonstrates sound judgment, patience, and maintains a professional demeanor at all times Exercises tact, discretion, sensitivity, and maintains confidentiality Performs essential job functions successfully in a busy and stressful environment Learns current and new computer applications and office equipment utilized at Bozeman Health Strong interpersonal, verbal, and written communication skills Analyzes, organizes, and prioritizes work while meeting multiple deadlines Schedule Requirements This role requires regular and sustained attendance. The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts. On-call work may be required to respond promptly to organizational, patient, or employee needs. Physical Requirements Lifting (Rarely - 30 pounds): Exerting force and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people. Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain. Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain. Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination. Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms. Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints. Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability. Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward. Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling. Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials. Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow. Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses. *Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%). The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified. 77211350 Compliance

**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

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).

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).

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.

Join our team as a Pharmacy Compliance Auditor - 340B Program and play a vital role in ensuring access to affordable medications for underserved communities. In this position, you will help safeguard the integrity of the 340B Drug Pricing Program-a federal initiative that enables healthcare organizations to stretch resources and provide comprehensive care to more patients. As a Pharmacy Compliance Auditor, you'll work closely with pharmacy leadership to conduct audits, monitor compliance, and identify opportunities for improvement. This role offers the chance to develop specialized expertise in 340B operations, gain advanced certifications, and make a meaningful impact on patient care and organizational success. If you are detail-oriented, passionate about compliance, and eager to grow in a critical area of pharmacy operations, we'd love to hear from you! Minimum Job requirements: * High School Diploma or GED (required) * Minimum of 2-3 years of experience in one or more of the following areas (required): * Technical Pharmacy * Hospital Pharmacy * Pharmacy purchasing * 340B program administration * Ability to successfully complete Apexus 340B University within six (6) months of hire (required) * Ability to successfully earn the 340B Operations Certificate within one (1) year of hire (required) * National Pharmacy Technician Certification (CPhT) is required. Accepted certifications include: * Pharmacy Technician Certification Board (PTCB) * ExCPT Certification through the National Healthcareer Association (NHA) * Must be currently registered as a Certified Pharmacy Technician with the Ohio Board of Pharmacy (required) Job Overview: The Pharmacy Compliance Auditor works under the supervision of the Sr. Director of Pharmacy and guidance of the 340B Pharmacy Compliance Coordinator to audit and monitor the 340B Program. Functions will include, but not limited to execution and documentation of daily, weekly, monthly, and quarterly audits to verify adherence with the 340B Program regulations and/or guidelines and as outlined in 340B policies and procedures. The 340B Drug Pricing Program is a US Federal program that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. Job Responsibilities: Accurately and efficiently performs 340B audits on a scheduled basis, including contract pharmacy, mixed use pharmacy, and outpatient pharmacy, and ensures compliance to the 340B Program. Addresses any reconciliations that arise. Monitors and audits state Medicaid claims. Uses Excel, to filter out non-eligible transactions. Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics. Maintains and audits the Prescriber file provided by Medical Staffing Office. Assists with external audits, as assigned. Maintains easily retrievable copies of audits and reports for compliance and audit purposes. Review's findings, issues, and steps taken to reconcile the issue with the Pharmacy Compliance Coordinator. Ensures that reporting meets organizational, regional, national, state, and federal requirements/guidelines. Routinely monitors industry publications and websites, and that organization has latest updates and information. Signs up for 340b webinars. Audits Contract Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Identifies and accumulates eligible matches from suspects. Maintains auditable records of purchases sent to Contract Pharmacies and payments made to the Covered Entity. Audits Outpatient Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Audits whether correct pricing plan was applied to Medicaid/Managed Medicaid. Audits the sub-clarification code 20 application to all FFS and MCO Medicaid claims, as well as verifying that the 08 code was applied. Identifies and accumulates eligible matches from suspects. Responsible for loan-borrow tracking. Maintains auditable records and facilitates inventory reconciliations. Compiles purchasing information, such a list of TriHealth purchasing accounts. Provides the Pharmacy Buyers with information needed to place orders using the appropriate accounts to replenish inventory in the mixed-use inventory setting. Verifies data integrity within 340B software and wholesaler/vendor purchase reports to after corrections and rebills are made and approves the order review in the queue. Provides root cause analysis and corrections of NDCs. Identifies and submits Individual wastes. Other Job-Related Information: * Healthcare system knowledge base/skills * Proficiency in Microsoft Office software, specifically Excel, Word, and Outlook * Ability to quickly learn technical systems such as EMR systems, retail pharmacy systems, and/or 340B software systems * Ability to work in a complex team environment and to collaborate with peers to complete required work * Strong interest in pharmacy practice advancement * Excellent verbal and written communication skills; communication style that is open and fosters trust, credibility and understanding. Working Conditions: Climbing - Rarely Concentrating - Consistently Continuous Learning - Consistently Hearing: Conversation - Frequently Interpersonal Communication - Consistently Kneeling - Rarely Lifting Lifting 50+ Lbs. - Rarely Lifting 11-50 Lbs. - Rarely Pulling - Rarely Pushing - Rarely Reaching - Rarely Reading - Consistently Sitting - Consistently Standing - Occasionally Stooping - Rarely Thinking/Reasoning - Consistently Use of Hands - Occasionally Color Vision - Consistently Walking - Occasionally TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS… * Welcome everyone by making eye contact, greeting with a smile, and saying "hello" * Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist * Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS… * Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met * Offer patients and guests priority when waiting (lines, elevators) * Work on improving quality, safety, and service Respect: ALWAYS… * Respect cultural and spiritual differences and honor individual preferences. * Respect everyone's opinion and contribution, regardless of title/role. * Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS… * Value the time of others by striving to be on time, prepared and actively participating. * Pick up trash, ensuring the physical environment is clean and safe. * Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS… * Acknowledge wins and frequently thank team members and others for contributions. Job keywords: Accredited Pharmacy Technician, Certified Pharmacy Technician (CPhT), Chemotherapy Pharmacy Technician (Chemo Pharmacy Technician), Compounding Technician, OR Pharmacy Tech (Operating Room Pharmacy Tech), RPhT (Registered Pharmacy Technician)

Join our team as a Pharmacy Compliance Auditor - 340B Program and play a vital role in ensuring access to affordable medications for underserved communities. In this position, you will help safeguard the integrity of the 340B Drug Pricing Program-a federal initiative that enables healthcare organizations to stretch resources and provide comprehensive care to more patients. As a Pharmacy Compliance Auditor, you'll work closely with pharmacy leadership to conduct audits, monitor compliance, and identify opportunities for improvement. This role offers the chance to develop specialized expertise in 340B operations, gain advanced certifications, and make a meaningful impact on patient care and organizational success. If you are detail-oriented, passionate about compliance, and eager to grow in a critical area of pharmacy operations, we'd love to hear from you! Minimum Job Requirements: Minimum of High School Degree or GED is required Must successfully complete: - Apexus 340B University, within the first 6 months in the position. - Advanced 340B Operations Certificate, within the first 12 months in the position Minimum of 2-3 years of experience in one or more of the following: - Hospital Pharmacy Technician. - Pharmacy purchasing. - 340B Program operations. Job Overview: The Pharmacy Compliance Auditor works under the supervision of the Sr. Director of Pharmacy and guidance of the 340B Pharmacy Compliance Coordinator to audit and monitor the 340B Program. Functions will include, but not limited to execution and documentation of daily, weekly, monthly, and quarterly audits to verify adherence with the 340B Program regulations and/or guidelines and as outlined in 340B policies and procedures. The 340B Drug Pricing Program is a US Federal program that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. Job Responsibilities: Accurately and efficiently performs 340B audits on a scheduled basis, including contract pharmacy, mixed use pharmacy, and outpatient pharmacy, and ensures compliance to the 340B Program. Addresses any reconciliations that arise. Monitors and audits state Medicaid claims. Uses Excel, to filter out non-eligible transactions. Evaluates patient eligibility for qualified and non-qualified patients in mixed-use areas and clinics. Maintains and audits the Prescriber file provided by Medical Staffing Office. Assists with external audits, as assigned. Maintains easily retrievable copies of audits and reports for compliance and audit purposes. Review's findings, issues, and steps taken to reconcile the issue with the Pharmacy Compliance Coordinator. Ensures that reporting meets organizational, regional, national, state, and federal requirements/guidelines. Routinely monitors industry publications and websites, and that organization has latest updates and information. Signs up for 340b webinars. Audits Contract Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Identifies and accumulates eligible matches from suspects. Maintains auditable records of purchases sent to Contract Pharmacies and payments made to the Covered Entity. Audits Outpatient Pharmacy matches and analyzes the causes of incorrect accumulations and reverses incorrect matches. Audits whether correct pricing plan was applied to Medicaid/Managed Medicaid. Audits the sub-clarification code 20 application to all FFS and MCO Medicaid claims, as well as verifying that the 08 code was applied. Identifies and accumulates eligible matches from suspects. Responsible for loan-borrow tracking. Maintains auditable records and facilitates inventory reconciliations. Compiles purchasing information, such a list of TriHealth purchasing accounts. Provides the Pharmacy Buyers with information needed to place orders using the appropriate accounts to replenish inventory in the mixed-use inventory setting. Verifies data integrity within 340B software and wholesaler/vendor purchase reports to after corrections and rebills are made and approves the order review in the queue. Provides root cause analysis and corrections of NDCs. Identifies and submits Individual wastes. Other Job-Related Information: Healthcare system knowledge base/skills Proficiency in Microsoft Office software, specifically Excel, Word, and Outlook Ability to quickly learn technical systems such as EMR systems, retail pharmacy systems, and/or 340B software systems Ability to work in a complex team environment and to collaborate with peers to complete required work Strong interest in pharmacy practice advancement Excellent verbal and written communication skills; communication style that is open and fosters trust, credibility and understanding. Working Conditions: Climbing - Rarely Concentrating - Consistently Continuous Learning - Consistently Hearing: Conversation - Frequently Interpersonal Communication - Consistently Kneeling - Rarely Lifting Lifting 50+ Lbs. - Rarely Lifting 11-50 Lbs. - Rarely Pulling - Rarely Pushing - Rarely Reaching - Rarely Reading - Consistently Sitting - Consistently Standing - Occasionally Stooping - Rarely Thinking/Reasoning - Consistently Use of Hands - Occasionally Color Vision - Consistently Walking - Occasionally TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS… • Welcome everyone by making eye contact, greeting with a smile, and saying "hello" • Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist • Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS… • Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met • Offer patients and guests priority when waiting (lines, elevators) • Work on improving quality, safety, and service Respect: ALWAYS… • Respect cultural and spiritual differences and honor individual preferences. • Respect everyone's opinion and contribution, regardless of title/role. • Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS… • Value the time of others by striving to be on time, prepared and actively participating. • Pick up trash, ensuring the physical environment is clean and safe. • Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS… • Acknowledge wins and frequently thank team members and others for contributions. Job keywords: Accredited Pharmacy Technician, Certified Pharmacy Technician (CPhT), Chemotherapy Pharmacy Technician (Chemo Pharmacy Technician), Compounding Technician, OR Pharmacy Tech (Operating Room Pharmacy Tech), RPhT (Registered Pharmacy Technician)