IHA · 2 months ago
Compliance Auditor/Educator - RSO - Remote
United States
Full-time
Remote
Entry, Mid Level
2+ years expIHA is dedicated to providing quality healthcare services, and they are seeking a Compliance Auditor/Educator to serve as a subject matter expert for coding procedures. This role involves developing educational materials, conducting audits, and providing guidance on compliance-related coding and documentation issues.
Health CareHospitalMedical
Responsibilities
Develops and leads audit projects for medical record integrity, service line or issues-related audits, identifies problems and uses professional judgment and independent assessment
Reports audit results utilizing a standard reporting process. Performs thoughtful and multi-layered consideration of medical decision-making in relation to the nature of the presenting problem and clinical documentation
Identifies new errors while performing audits, investigates and assesses the root cause of errors and develops corrective action plans
Performs one-on-one Audit Meetings with Providers for corrective educational guidance; develops corrective action plans and related educational materials
Assists in the planning, organizing and completion of auditing activities required to comply with federal payers and other compliance-related requirements
Researches federal, payer coding and documentation requirements and develops comprehensive written processes and guidelines for correct coding tailored to specific situations and encounters. Performs critical analysis to apply complex coding rules to specific work processes and develops thoughtful, multi-layered recommendations and adjustments to office and department work flows to better comply with the standards
Monitors audit trends to identify errors in coding and documentation, lost revenue opportunities and any overpayments made due to errors in coding, insufficient medical record documentation, reports findings. Recommends process improvement strategies to IHA offices and departments. Monitors to completion
Educates Providers on correct coding principles and works with Providers to increase and strengthen health care providers' awareness and understanding of medical record documentation guidelines and coding principles
Serves as a subject matter expert in all areas of coding, documentation and audits. Acts as a key contact for Providers, Revenue Department and Managers for coding questions. Works as the liaison between multiple departments to provide guidance, service as the subject matter expert and follows events to proper resolution
Provides training for IHA staff and providers on CPT, ICD 10, and HCC coding standards and procedures
Works closely with the Physician Coding Champions to develop and present effective coding education to Providers and Managers. Requests agenda time and presents corrective education based on audit findings to large Provider groups. Follows up on issues and implements actions plans
Develops job aids for all specific areas of specialty education needed. Addresses barriers to improvement while recommending action steps to improve performance
Develops coding articles for the monthly newsletter
Processes Queries via the Event System, all specialties
Rand guidelinesers on correct coding principles and
esponds to event reports, reviews the problem and provides independent assessment and problem solving; develops corrective actions
Monitors billing event trends to analyze outliers and high trends; makes recommendations to resolve and promotes prevention steps
Collaborates with IHA’s Compliance Team and Trinity Integrity and Compliance leaders to maintain coding standards and procedures in alignment with regulatory and payer requirements
Analyzes RBRVU data in correlation to IHA's fee schedule
Effectively navigates and analyzes systems and makes recommendations for change in Business System and Medical Record Systems, specifically with respect to proper billing, documentation and office procedures
Drives to offices and other training sites to educate staff and/or providers
Performs other duties as assigned
Qualification
Required
Bachelor's Degree or equivalent combination of education and experience
Certified Professional Coder or RHIT is required
2 years of experience coding, reimbursement analysis, insurance issue resolution and medical record auditing
Demonstrated understanding and/or hands-on experience with office processes, procedures and workflows
Subject matter expert knowledge of managed care and insurance practices, insurance claims and billing process, fee schedules and pricing
Maintains substantial working knowledge of federal, state and insurance company regulations and contract requirements affecting compliance in a healthcare setting
Ability to independently review and apply high critical thinking skills, consider medical necessity of the presenting problem and analyze levels of medical decision-making
Ability to apply logic to assumptions and decision-making for areas that are not a black or white assumption
Proficiency in multi-tasking and meeting sensitive deadlines in a fast-paced environment with a personal commitment to producing the highest quality work and providing extraordinary customer service
Possess excellent customer service and problem-solving abilities, collaborative and positive coaching skills
Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, PowerPoint, intranet and computer navigation
Excellent professional communication skills in both written and verbal forms, such as via query, including proper phone etiquette
Ability to create education materials, implement and present effective group educational sessions to providers
Ability to work collaboratively in a team-oriented environment; displays courteous, professional and friendly demeanor
Ability to work effectively with various levels of organizational members
Good organizational and time management skills to effectively juggle multiple priorities and time constraints in a fast-paced environment
Ability to exercise sound judgment and problem-solving skills
Ability to maintain any organizational information in a confidential manner
Successful completion of IHA competency-based program within introductory and training period
Ability to travel to offices and other training sites to educate staff and/or providers
Ability to work overtime hours as scheduled
Physical activity that often requires keyboarding, filing and phone work
Physical activity that often requires extensive time working on a computer and sitting
Physical activity that sometimes requires walking, bending, stooping, reaching, and/or twisting
Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs
Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus
Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment
Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English
Preferred
Certified Auditor or HIM designation
Company
IHA
Established in 1994, Trinity Health IHA Medical Group is one of the largest multi-specialty medical groups in Michigan delivering more than one million patient visits each year, practicing based on the guiding principle: our family caring for yours.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Annie Steiner
Human Resources Business Partner
Catherine TerBush, SHRM-CP
Senior HR Business Partner
Company data provided by crunchbase