UofL Physicians

  • Compliance Auditor

    Job Locations US-KY-Louisville
    Job ID
    2017-4092
    # of Openings
    3
    Category
    Administrative/Finance
    Department
    ULP Compliance
  • Overview

    General Summary: A non-exempt position responsible for conducting professional coding and documentation audits with follow-up face-to-face, telephonic and/or web-based education with providers.

    Responsibilities

    Essential Functions:

    1. Conducts medical record documentation reviews of CPT-4 and ICD-10-CM coding according to set schedule for all ULP billing providers and ULP Coders.
    2. Completes individual and departmental coding summary reports , provides explanation of findings and offers education.  Coordinate and provide ongoing training and education to providers and ancillary staff on documentation improvement initiatives related to the selection of CPT (especially E/M levels), ICD-10-CM and HCPCS in accordance with federal, fiscal intermediary and organizational specific guidelines. Training and education will be initiated after review of audit results. Compliance auditor should maintain a competent understanding of all coding regulations and guidelines, coding updates and applicable clinical knowledge (i.e. anatomy and physiology, disease processes, procedures) necessary to be a proficient provider compliance education resource.
    3. Shadow providers when appropriate and work on individual coding and documentation goals outlined by Provider, AVP of Compliance and/or as directed by Compliance Committee after audit results reviewed if necessary.   Ability to accurately interpret encounter forms, medical records, physician documentation, lab and operation reports and other documents necessary for accurate billing and coding.
    4. Utilizes MD Audit software to audit medical records, generate reports, analyze for trends and initiate provider or staff education.
    5. Reviews and explains audit results with AVP of Compliance and/or Corporate Compliance.
    6. Prepares, initiates and monitors provider and departmental post-audit followup action plan based on review findings.
    7. Keeps informed on coding and documentation guidelines, federal and state compliance regulations. Ability and ease with presenting education information to group and individual providers. Critical thinking skills to look at “total” picture and ability to research topics to better understand and explain complex medical coding/billing issues as required.
    8. Reviews and processes refund/rebill and missed revenue reports to AVP, monthly (investigational audit) or quarterly (routine audit).

    Qualifications

    Education: Minimum of 3 years of experience with a licensure and/or certification in at least one of the following: RHIA, RHIT, CCS, CCS-P, and CPC.

    • Additional credential of Certified Professional Medical Auditor (CPMA) within 1 year of position employment .

     

    Experience: A minimum of 3 years CPT and ICD-10 coding and/or documentation and billing auditing for providers.

     

    Other Requirements: Must maintain a valid driver’s license and have reliable transportation for the purposes of meeting with providers at our various clinic/hospital locations.

     

    Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

     

    Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work. Requires travel to and from the ULP campus.

     

    Mental/Physical Requirements:

    • Involves sitting approximately 80 percent of the day, walking or standing the remainder.
    • Must be able to walk long distances at the different clinic/hospital locations for provider meetings and educational presentations.
    • Must be able to employ a diplomatic approach when meeting with providers and delivering audit findings, understanding that the findings may at times be ill received, yet not wavering in the departmental duty to remain objective towards compliance

    Core Competencies:

     

    Knowledge:

    • Knowledge of health care regulations and standards as they apply to correct coding.
    • Understands regulatory and organizational guidelines and remains aware of changes in the healthcare environment.
    • Working knowledge of ICD-10-CM and CPT coding guidelines and conventions.

    Skills:

    • Skills in interpersonal communication.
    • Skills in efficient use of time, i.e. time management skills
    • Skills in analytics.

    Abilities:

    • Able to interpret documentation, billing, and coding guidelines.
    • Able to organize work priorities and meet deadlines while handling large volumes of work.
    • Maintains a professional and cooperative attitude with providers, co-workers, and employers.
    • Able to maintain confidentiality of all compliance related information.

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