The Compliance Auditor will perform compliance audits for providers and the billing team. The Compliance Auditor will review medical record documentation to determine accuracy of assigned CPT, ICD-10-CM, HCPCS, and modifiers. The Compliance Auditor is a professional level position working in Compliance and with all levels of the organization. In this role you will have the ability to develop skills and gain experience working on a wide range of regulatory compliance topics, under direction of the Compliance Program management. This is a great opportunity for someone with a strong desire to learn, and who wants to further develop their skills in the healthcare compliance realm.

• Minimum 2-3 years' work experience with completion of a certified coding program, (CPC, CCS, CCS-P, RHIA, RHIT)
• CRC or risk adjustment coding knowledge/experience preferred
• AAPC or AHIMA auditing credentials (CPMA, CDEO, CDIP) or commitment to start process for certification within first 6 months of employment
• Experience in a primary care setting (FQHC/RHC/CBHC experience preferred)
• Behavioral health coding/auditing experience (Preferred)
• Minimum 1 year conducting provider/coder education and/or audits (4-5 years preferred)
• Current knowledge of CPT, ICD-10-CM, HCPCs, and modifiers
• Understanding of medical terminology and anatomy
• Experience working with Medicare, Medicaid, and private payers
• Investigative and research skills
• The desire to learn and the desire to teach are fundamental to the success in this role

Key Success Factors:

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  Excellent verbal and written communication skills, including Microsoft Suite
• Proficient in billing and coding requirements for federal and private payers
• Self-motivated, with a desire to enhance coding and compliance skills and knowledge
• Excellent organizational skills and attention to detail
• Exceptional time management, priority setting skills, and ability to multi-task
• Proven problem-solving skills
• Ability to understand copious amounts of information and distill it down to the key facts
• Service oriented to consistently engage and build relationships at all levels of the organization
• Ability to recognize and assess sensitive situations and compliance matters understanding the need to support confidentiality, and work to resolve issues in a timely manner

Essential Functions:

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  Performs provider audits to ensure accuracy of CPT, ICD-10, HCPCS, and modifiers reported.
• Performs quality audits of billing team in the event of a coding change, to ensure compliance with coding guidelines and company policies for complete, accurate, and consistent coding
• Act as a coding and compliance resource for staff member questions
• Stay current on, and communicate, changes in coding rules and regulations
• Responsible for researching, reviewing, and interpreting federal and state regulations
• Assist with creating, maintaining, and delivering education content to providers and billers to support documentation improvement as needed.
• Assist with supporting the Heritage Health Compliance Program to include policies & procedures, HIPAA privacy rules, and participating on projects or investigations
• Travel to and from Heritage Health sites to participate in training, projects, or investigations.
• Commitment to professional growth and understanding of the changing environment through current events reading, continuing education, self study, cross-functional training, and work assignment variation.
• Remain current on certifications and coding compliance rules and regulations
• Other duties as assigned

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