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Compliance Auditor / Regulatory Compliance / Sharp Rees-Stealy / Day Shift / Full - Time / Sign-on Bonus: $1,500

Job ID JR_114000 Date Posted 01/06/2022
San Diego, California
  • Copley Drive
  • Day
  • Regular
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Responsibilities

Hours

Shift Start Time:

Variable

Shift End Time:

Variable

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No


Required Qualifications

  • Two years of college or five years working experience in a healthcare environment related to auditing of medical records and CMS compliance.
  • 3 Years Experience auditing coding and medical record documentation in an ambulatory care setting.
  • Experience developing training materials and presenting to a large group of professionals.
  • Certified Professional Coder (CPC) OR Certified Coding Specialist--Physician-based (CCS-P) -REQUIRED


Essential Functions

  • Participates in audit risk assessment for each division/provider to determine trends and helps management identify need for more frequent audits.
  • Is able to analyze and create concise reports quantifying and summarizing audit findings. Presents the findings to Departments, Divisions, and at the Individual Provider level.
  • Adheres to audit schedules and deadlines; prioritizes workload; communicates to management appropriately regarding workload and priority concerns.
  • Utilizes internal and professional resource tools to provide quality audit results.
  • Performs concurrent audits according to a defined audit schedule to assure that the documentation meets the standards set by CMS, local Medicare Administrative Contractor (MAC) and other third party payers.
  • Performs provider quality audits to ensure provider is billing to meet established coding guidelines.
  • Client, Provider, Clinical, and Coding Support
  • Serves as a resource providing support to SRS management, physicians, administrative and support staff for coding, documentation and compliance.
    Provides support with TES/CM edit resolution at assigned sites and assists with coding related edit questions.
  • Provides professional and courteous support to providers, clinical staff, PFS, via email, phone and in-person contact, answering questions and providing supporting documentation for compliance standards.
  • Communication and training
  • Effectively communicates audit results to supervisor, manager and/or director as appropriate.
  • Provide timely feedback and final resolution of identified issues.
  • Schedules and provides 1:1 training to provider to ensure maximum coding compliance guidelines are followed.
  • Evaluates the inpatient and outpatient training and coding areas for improvement for assigned specialties and incorporates education specific to the needs of the specialty.
  • Develops and maintains tools, guidelines and procedures to assist in provider's understanding of requirements for medical documentation and coding.
  • Performs training for new providers with timely feedback on their documentation.
  • Has a thorough understanding of ICD-10 and CPT coding guidelines.
  • Protects all work products, working papers, personal lap top, and other related documents and/or portable electronic data systems in accordance with SHC and regulatory privacy and confidentiality guidelines.
  • Stays current with Medicare updates and specialty specific professional services updates; communicates changes to management.
  • Data collection and reporting
  • Designs and develops reports within a specified timeframe.
  • Analyzes trends while reviewing documentation and communicates to management.
  • Reports findings identified during documentation reviews and includes official references related to the findings.
  • Reviews coding publications for changes, clarifications and/or information pertinent to the medical group's specialties/services.
  • Attends and participates in job related conferences, seminars and workshops to enhance skills and keep current on coding and documentation changes.
    Presents to management complete supporting documentation associated with areas of concern.


Knowledge, Skills, and Abilities

  • Excellent working knowledge of CPT, ICD-10 and HCPCS codes is required.
  • Thorough understanding of Medicare, insurance documentation, and compliance and coding requirements.
  • Expert knowledge of MS Office which includes: Excel, Word, and PowerPoint.
  • Ability to educate and train all levels of clinical and professional staff.
  • Excellent interpersonal skills verbal and written, with the ability to communicate to all levels of staff within the organization.
  • Ability to produce high quality work/reports with minimal error rate.
  • Professional approach to work including ability to exercise mature judgement and maintain confidentiality in all activities.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA); Certified Professional Coder (CPC) - AAPC
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