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SouthEast Alaska Regional Health Consortium (SEARHC) · 1 day ago

Compliance Auditor

Juneau, AK

Full-time

Hybrid

Mid Level

$47.69/hr - $67.19/hr

3+ years exp

SouthEast Alaska Regional Health Consortium (SEARHC) is a non-profit health consortium serving the health interests of Southeast Alaska residents. The Compliance Auditor will ensure compliance with federal and state regulations regarding healthcare coding, documentation, and billing practices, while conducting audits and providing training to staff.

Health CareNon Profit

Responsibilities

Conduct Audits: Review health record documentation, claims, coding, policies and processes to identify compliance or non-compliance with SEARHC policies, state and federal laws and regulation, Medicare/Medicaid regulations, and national coding standards

Analyze Data: Examine data to identify patterns and trends for compliance or non-compliance

Identify Risk: Analyze audit results, data, policies, and processes to assess risk

Develop Audit Plans: Create audits based on risk assessments, billing practices, new services, Medicare/Medicaid risk areas, Medicare/Medicaid audits, and RAC and PERM audits

Prepare Reports: Document audit findings and recommendations. Present reports to the Compliance Director, Chief Legal Officer, Division Vice President, Compliance Committee and Accreditation Governing Body

Training and Education: Prepare and provide training and education to staff in response to audit findings, and staff inquiries

Assist the Compliance Director as needed

Work closely with legal counsel when interpreting billing laws and regulations

Receive and investigate compliance and HIPAA complaints during absence of the Compliance Director

Qualification

Healthcare complianceMedical coding classificationCompliance auditingElectronic health record systemsProfessional Coder certificationWriting reportsTrainingEducationEffective communicationProblem-solving

Required

Certification as Professional Coder, Coding Specialist, Inpatient/Outpatient Coder

Minimum of three years' compliance auditing or health records coding in a healthcare entity

Healthcare compliance, health care coding and billing process, medical coding classification (CPT, ICD, HCPCS) rules, Medicare/Medicaid documentation rules, State and Federal medical record requirements and guidelines

Medical terminology

Electronic health record systems

Writing reports, preparing training and education presentations, effective communication, problem-solving, reading and interpreting laws and regulations

Audit health records for documentation, coding, and billing purposes; investigate compliance concerns; prepare written reports for audits; meet deadlines; understand compliance and regulatory issues; use effective training and communication skills; listen and understand; resolve conflict; analyze data; transform data into meaningful reports; work under pressure; multitask; and function independently

Certified Coding Associate - American Health Information Management Association