Cooper University Health Care · 1 month ago
COMPLIANCE AUDITOR PROF SVCS - REMOTE
United States
Full-time
Remote
Mid Level
3+ years expCooper University Health Care is dedicated to providing extraordinary health care through a commitment to innovation and employee development. The Compliance Auditor is responsible for reviewing professional fee billing, coding, and documentation to support the corporate compliance program and ensure adherence to regulations and internal policies.
Health CareInnovation Management
Responsibilities
Performance of timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy, identify compliance related risks, internal control weaknesses, revenue capture opportunities and assist in determining the root cause of any identified non-compliance with government rules and regulations, state laws and Cooper policies and procedures
Preparatory work for reviews/audits including developing a scope of work
Reviewing available documentation
Analyze/review audit data and prepare reports for review and presentation to management, providers and departments, making recommendations for improvement
Determine charge corrections and refunds resulting from compliance reviews and ensure they have been completed
Post-review/audit education/training when applicable
Performing follow-up reviews when necessary
Ensuring appropriate work papers, either paper or electronic, are maintained in accordance with regulations/policy
Assist in the development of policies and procedures that establish standards for compliance, as well as preparation of other guidance documents and tools to assist Coper providers and staff in appropriate billing, coding and documentation
Serve as liaison for questions, concerns, incidents and complaints regarding compliance matters, responding directly to the inquiry and/or consulting or interacting with other team members or departments
Inform Chief Compliance Officer of major findings; based on types of questions/concerns received, recommend remedial correction and prevention actions; identify education/awareness opportunities and guidance topics
Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes
Qualification
Required
Demonstrated knowledge and understanding of provider professional fee billing, coding and documentation practices in inpatient and outpatient settings
Demonstrated expertise in medical terminology
Demonstrated expertise in healthcare coding (CPT, ICD-9, ICD-10, APC, HCPCS)
Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information (PHI)
Demonstrated knowledge and understanding of federal and state statutes, laws, rules and regulations affecting billing, coding and documentation practices in support of healthcare services provided to beneficiaries of federally-funded healthcare programs and other third party payers
Demonstrated knowledge and understanding of the essential elements of an effective compliance program
Working Knowledge And Understanding Of provider professional fee revenue cycle and reimbursement
Working Knowledge And Understanding Of electronic billing and medical record systems
Working Knowledge And Understanding Of sampling technologies and statistical analyses
Experience using personal computers required
Current certification as a CPC or COC
Current CPC or COC
Valid driver's license and automobile insurance per company policy
Preferred
3+ years' experience in an academic medical center preferred, with emphasis on provider compliance activities, including but not limited to: auditing, monitoring, investigation and training
Experience using the following applications is desirable: Word, Excel, e-mail, and healthcare related billing systems
Experience using MDAudit audit software and/or EPIC EMR desirable
Benefits
Health, dental, vision, life, disability, and retirement
Comprehensive benefits program
Attractive working conditions
Opportunities for career growth through professional development
Company
Cooper University Health Care
Cooper University Health Care is the leading academic health system in South Jersey and provides access to primary, specialty, tertiary, and urgent care, all within one complete health system.
Founded in 1887Camden, New Jersey, USA
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.1MKey Investors
Foundation For Health Advancement
2023-08-14Grant· $0.1M
Leadership Team
Anthony Mazzarelli
Co-President / Chief Executive Officer
Brian Reilly
Chief Financial Officer
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