Sr. Compliance Auditor

About the position

We are seeking a Sr. Compliance Auditor who will provide on-going training and support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the clinical departments, Physicians Billing Service, and the Johns Hopkins Health System Compliance Office. The documentation audits are conducted as part of the School of Medicine's Billing Quality Assurance Compliance Program. Prepares reports for the Sr. Director, Director, and clinical departments regarding the status or results of the reviews. Summary results are presented to the Clinical Practice Association's Board of Governors, the University's Trustee Committee for Audits and Insurance and other appropriate offices within the School of Medicine or Johns Hopkins Medicine.

Responsibilities

• Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
• Verifies and corrects as necessary, the audit work completed by the Billing Compliance Auditors or other Sr. Auditors/Trainers.
• Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
• Assists departments and providers in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities.
• Conducts training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
• Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed.
• Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.
• Regularly monitors potential billing problems and/or billing errors identified by each departments' professional fee billing office.
• Prepares and revises as needed a Compliance Training Manual for routine and special training programs.
• Assists in the development of medical record documentation standards and requirements related to clinical services billing.
• Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.
• Performs other compliance related activities as necessary.

Requirements

• Bachelor's Degree in health care-related or business-related field.
• Five years of auditing/billing compliance required.
• A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.
• Recent experience with Medicare regulations required.
• Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required.
• CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.
• Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.
• Demonstrated communication, analytical and organizational skills are essential.
• Demonstrated training or teaching experience required.
• Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.

Nice-to-haves

• Experience with Epic Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, IDX and other clinical information systems.
• Seven years of experience.
• Additional coding certifications.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k
• Paid holidays
• Paid volunteer time
• Tuition reimbursement
• Professional development