Compliance Auditor

PRIMARY FUNCTION : Under general supervision, using a unique combination of clinical expertise and billing knowledge, the Compliance Auditor monitors and improves the quality of clinical and financial documentation related to the provision of patient services. The Compliance Auditor will compare clinical and financial records to ensure that the documentation provided supports the patient charges listed.The Compliance Auditor will utilize our technology to codify and quantify findings to assist with reporting, monitoring and educating where appropriate. ESSENTIAL FUNCTIONS: Performsaudits of clinical documentation of physician, technical or specialty (e.g., Home Health, Hospice, Inpatient Rehab) billing and payment records and applicable industry standard billing codes by analyzing medical records, coding records and health system bills validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding, determining that governmental and third party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures. Evaluatesaccuracyof coding and billing performance by individuals, coders and clinical units. Preparesreports to assist Compliance Educators in identifying areas of risk based on the audit for education to providers. Workscollaboratively with appropriate personnel to identify and recommend strategies for process improvement related to our internal auditing processes. Coordinatesresponses to and analyzing risk associated with audit requests from government and commercial payers. Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Develop and conduct clinical documentation audit project plans. Develop and maintain complex audit processes and audit tools. Audit established guidelines for medical necessity and other specialty clinical services provided in acute care and ambulatory settings. Identify patterns or trends that require auditing in our data tool. OTHER FUNCTIONS AND COMPETENCIES Majority of role will be spent (gt;80%) auditing, additional asks may be focused around education and training of providers and providing written compliance guidance to Jefferson employees for clinical documentation, coding and billing. Participate in compliance-related investigations and remediation efforts. INTERNAL/EXTERNAL CONTACTS: Audit Manager, Sr. Director and VP of Compliance Revenue Risk Intelligence, Sr. Director of Provider Success, Educators EXPERIENCE REQUIREMENTS: Minimum of three (3) years of progressive experience in coding, reimbursement and regulatory compliance audits either through employment, consulting or other appropriate capacity is required EDUCATIONAL/TRAINING REQUIREMENTS: Bachelorrsquo;s degree in Health Information Management or related field CERTIFICATES, LICENSES, AND REGISTRATION: One or more of the following certifications required: CPC (Certified Procedural Coder), CCS-P (Certified Coding Specialist - Physician) RHIA (Registered Health Information Management Administrator), RHIT (Registered Health Information Management Technician), COC (Certified Outpatient Coder), CIC (Certified Inpatient Coder), additional certifications in specialty areas is highly encouraged Epic certification or experience with Epic ADDITIONAL INFORMATION: Proven ability to manage change. Strong knowledge of federal and state laws, third-party payer and regulatory requirements. Strong communication and interpersonal skills with a high degree of professionalism related to engaging with clinicians and provider support. Effective problem solving skills. Ability to work in a complex environment with the skills to manage multiple projects and deadlines, establish priorities, set objectives, and achieve stated goals. Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson. Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds. Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science. Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnetreg;-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership. Jeffersonrsquo;s mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results. OUR MISSION: We improve lives. OUR VISION: Reimagining health, education and discovery to create unparalleled value OUR VALUES: Put People First, Be Bold Think Differently and Do the Right Thing As an employer, Jeffersonmaintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.

Created: 2024-11-05