The Compliance Auditor performs comprehensive audit of care center locations/divisions. They review patient charts for accurate documentation of medical codes for diagnoses, procedures, and services performed by OB/GYN physicians and other qualified healthcare providers. The Compliance Auditor evaluates key administrative, operational and compliance requirements and informs leadership and the Executive team of audit findings, potential deficiencies, and assists in the development of corrective action plans. The Compliance Auditor also communicates with upline management of identified trends and areas of risk and provides overall recommendations for improvement in the patient experience, clinical outcomes, and mitigation of risk to the Company.
PRIMARY RESPONSIBILITIES/JOB FUNCTIONS:
- Perform pre and post billing patient chart reviews to ensure the clinical documentation provides evidence of compliance with coverage requirements, Company policy, and regulatory... requirements including evaluation and management, surgery, radiology, pathology, and medicine.
- Conduct complete and timely comprehensive audits as assigned.
- Keep abreast of all Company policies/procedures, local/state/federal laws/regulations, and serves as resource to care center locations/divisions in these areas.
- Communicate with the Compliance/Legal Department any reportable findings or matters identified during the audit that would put the Company at risk.
- Communicate and inform the care center locations/divisions and leadership of audit findings and corrective action and/or performance improvement plans.
- Participate in special projects and performs other duties as assigned.
- Certified Professional Coder (CPC) credentialed with a minimum of three years of medical coding experience
- Knowledge of physician group practice, standards of medical record maintenance and documentation, medical coding, reimbursement concepts, and local/state/federal regulatory requirements
- Demonstrated organizational skills, ability to meet deadlines, and work independently in remote environment
- Excellent verbal/written communication and presentation skills required
- OB/GYN experience preferred
- All auditors must maintain a valid and current coding
- Minimal travel required