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Compliance Auditor

3+ years
$53K/yr - $74K/yr
10 Aug. 26, 2024
Job Description
Job Type: Full Time Education: B.Pharm/ M.Pharm/ B.Sc/ M.Sc/Any Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Position: Compliance Auditor

Company: CareAbout Health

Location: Remote

FLSA Category: Non-exempt, Hourly

Reports To: Director of Medical Coding & Compliance Auditing

Company Overview: CareAbout Health is a managed services organization (MSO) dedicated to enhancing healthcare through expert advice, resources, and support for medical groups and healthcare-focused companies. We strive to align incentives across patients, providers, and payers to achieve high-quality, cost-effective care and better outcomes.

Role Summary: The Compliance Auditor will conduct medical coding audits to ensure documentation compliance with CMS and payor guidelines. This role involves reviewing medical records, identifying coding discrepancies, and preparing detailed reports.

Key Responsibilities:

  • Audit documentation to ensure accurate assignment of ICD-10 codes, CPT codes, and modifiers for both facility and provider-based clinical documentation.
  • Conduct audits to identify under-coded and over-coded services, and prepare comprehensive reports on findings.
  • Research and address inquiries from the Legal Team and other departments regarding compliance issues, coding inaccuracies, denials, and billable services.
  • Generate reports as required using various systems.
  • Maintain knowledge of payer requirements for NJ, NY, PA, and FL.
  • Perform other job-related duties as assigned.

Qualifications:

  • Associate or Bachelor’s degree.
  • Minimum of 3 years of experience in medical coding, reimbursement, and regulatory compliance audits.
  • Certification from AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders), such as:
    • Certified Professional Medical Auditor (CPMA)
    • Certified Professional Coder (CPC)
    • Certified Coding Specialist (CCS)
    • Registered Health Information Administrator (RHIA)
    • Registered Health Information Technician (RHIT)
  • Proficiency in Microsoft Office Suite and Windows 10.
  • In-depth knowledge of auditing concepts, medical coding, and billing systems, and regulatory requirements.
  • Strong analytical skills with the ability to manage confidential information and solve complex problems.
  • Excellent communication and interpersonal skills.
  • Familiarity with legal, regulatory, and policy compliance issues related to medical coding and billing.
  • Ability to adapt and modify procedures and protocols as necessary.
  • Capability to provide guidance and training to staff in coding and compliance.

Physical Requirements:

  • Primarily sedentary role, involving sitting at a desk for most of the day.
  • Minimal standing or walking, less than two hours per day.
  • Occasionally lift up to ten pounds.
  • Must be able to work at a computer and handle phone calls regularly.

Compensation: Salary is based on role requirements, education, experience, skills, location, and internal equity.

Equal Opportunity Employment: CareAbout Health is committed to creating a diverse and inclusive work environment. We offer equal opportunities to all applicants and employees regardless of race, color, creed, religion, national origin, age, sex, gender, sexual orientation, marital status, military service, veteran status, disability, or any other protected characteristic.

Note: We are currently unable to offer visa sponsorship. Applicants must be legally authorized to work in the United States.

How to Apply: Interested candidates should submit their resume for consideration.