Compliance Auditor II - Ambulatory (Remote)

About the position

The Compliance Auditor II - Ambulatory works with the Ambulatory Services Compliance Director and Compliance Audit Manager to develop, provide, and communicate recommendations and education to department leadership and providers based on audit findings. This role assists the Director of Ambulatory Compliance Services in performing federal and state regulatory research, making presentations to internal and external audiences, and providing education to departments on compliance guidelines.

Responsibilities

• Conduct regular and comprehensive audits to assess the effectiveness and accuracy of internal controls, financial records, and compliance with laws, regulations, and the health system's policies and procedures.
• Identify compliance issues, assess risks, and recommend solutions to resolve the issues.
• Analyze and prepare reports on audit findings, including recommendations to enhance compliance and mitigate risk.
• Stay updated on new laws and regulations affecting the health system's operations and internal policies.
• Routinely audit providers' charges and medical charts to review coding procedures for compliance with regulations and billing accuracy.
• Review and educate HIM coding and billing staff as necessary.
• Demonstrate competence in critical thinking, interpersonal relationships, and technical skills.
• Prepare clear, concise audit workpapers.
• Mentor providers on billing and coding compliance.
• Follow up with auditees to ensure timely management responses and determine the implementation status of recommendations.
• Serve as a resource for compliance queries from various stakeholders.
• Conduct meetings with providers to review findings and recommendations.
• Utilize audit procedures and analytical tools for special projects.

Requirements

• High School Graduate
• 3 or more years of medical chart auditing experience
• 5 or more years of CPT coding experience in a medical field
• Proficient knowledge of medical terminology, ICD-10, and CPT codes
• Knowledge of Medicare and other federal/state compliance guidelines
• Excellent communication skills
• Three years of previous medical charts auditing experience
• Coding certification

Nice-to-haves

• Bachelor's Degree