Talent.com
Compliance Coding Auditor for the Auditing, Tracking, and Monitoring
Compliance Coding Auditor for the Auditing, Tracking, and MonitoringAdvanced Medical Management, Inc. • Bakersfield, CA, US
Compliance Coding Auditor for the Auditing, Tracking, and Monitoring

Compliance Coding Auditor for the Auditing, Tracking, and Monitoring

Advanced Medical Management, Inc. • Bakersfield, CA, US
25 days ago
Job type
  • Full-time
Job description

THE ROLE

As a member of AMM's Compliance and Ethics team, the Compliance Coding Auditor is an important driver of our mission. They are responsible for supporting the Company's Compliance & Ethics Program (the Program) auditing, tracking, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM's key stakeholders, including patients and their families and government agencies, and AMM is committed to exceeding those expectations. The Program is led by AMM's CCEO, who reports to AMM's Chief Executive Officer and the AMM Board, and who oversees and manages the AMM Compliance Committee, consistent with industry best practices.

The Compliance Coding Auditor for the Auditing, Tracking, and Monitoring team is expected to exemplify the Company's culture and core values. This is a role that requires sound and risk-aware judgment, productive collaboration across the Company, and demonstrated success in performing audits to determine organizational integrity of billing and risk adjustment metrics, including : appropriate documentation, accurate coding and billing, and / or medical necessity of services billed.

ESSENTIAL DUTIES & RESPONSIBILITIES

The following description provides an overview of primary responsibilities for this position; it should not be interpreted as all-encompassing.

General Responsibilities

  • Ensures that the Manager is timely informed of all key findings of internal compliance tests and assessments, audits, and monitoring initiatives.
  • Undertakes to remain informed of relevant developments and trends in healthcare compliance and ethics by, among other things, attending seminars, reviewing professional journals, and actively participating in professional organizations, and leverages that insight and knowledge to enhance the Program.

Auditing, Testing, and Monitoring-Specific Responsibilities

  • Performs internal compliance department audits based on departmental planning to determine accuracy and adequacy of documentation and coding related to physician billed services based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.
  • Prepares written reports of audit findings, with recommendations, and presents to the Manager for review and presentation to appropriate stakeholders; maintains audit records.
  • Performs focused audits as needed in response to reported compliance and ethics concerns, with direction from the Manager of Auditing, Testing, and Monitoring.
  • Ensures that written evaluative reports of findings are developed for all initiatives undertaken.
  • In collaboration with the appropriate business unit leader, supports corrective action plans to address systemic issues or pervasive practices that could give rise to potential violations of applicable laws, regulations, or AMM's Code of Conduct and / or policies and procedures.
  • Other duties as assigned
  • EDUCATION & EXPERIENCE

  • Required five to ten years of relevant professional experience in healthcare, including coding and / or auditing roles. Experience auditing healthcare claims in a professional services firm and / or in-house at a large healthcare provider organization, health system, and / or payer.
  • An undergraduate degree; preference for Health Business or related field.
  • In lieu of an undergraduate degree, HS Diploma / GED and five (5) additional years of relevant experience will be considered
  • Required coding certification, preferred Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC), from the American Academy of Professional Coders (AAPC)
  • Required top-tier healthcare audit certification, preferred Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders (AAPC) along with a fundamental understanding of regulatory framework and coding practices.
  • Fundamental understanding of government healthcare programs (i.e., Medicare and Medicaid).
  • Demonstrated ability to work effectively with key internal and external stakeholders.
  • PROFESSIONAL PROFILE

    Key Professional Skills

  • A demonstrated ability to cultivate working relationships with representatives from government agencies.
  • An ability to operate successfully in a flat culture, with the courage and competence to engage on multiple fronts and tackle challenges head-on.
  • An ability to prioritize effectively, and exercise sound judgment, in a fast-paced, physician-driven environment.
  • A demonstrated ability to accurately apply the necessary methodologies, professional standards, and government agency expectations for conducting healthcare auditing, testing, and monitoring activities.
  • Personal Characteristics

  • Exemplary integrity with courage and an unwavering ethical compass.
  • Pragmatic, risk-aware professional judgment.
  • Demonstrated tact, trustworthiness, and diplomacy skills needed to manage sensitive and confidential information such as protected health information.
  • An adept listener with a sense of humility.
  • Capable of earning the respect and confidence of colleagues through demonstrated professional excellence and expertise.
  • Prompt and efficient ability to manage shifting priorities, demands and timelines.
  • Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.
  • AMM BENEFITS

    When you join AMM, you're not just getting a job—you're getting a benefits package that puts YOU first :

  • Health Coverage You Can Count On
  • Full employer-paid

    HMO and the option for a flexible PPO plan

  • Wellness Made Affordable
  • Discounted

    vision and dental premiums to help keep you healthy from head to toe.

  • Smart Spending FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
  • Work-Life Balance
  • Generous

    PTO 40 hours of sick pay , and 13 paid holidays to enjoy life outside of work.

  • Career Development Tuition reimbursement to support your education and growth.
  • Team Fun Paid company outings and lunches because we work hard, but we also know how to have fun!
  • Create a job alert for this search

    Compliance Auditor • Bakersfield, CA, US

    Related jobs
    EPIC COGITO & RADAR Analyst (100% REMOTE / NO C2C)

    EPIC COGITO & RADAR Analyst (100% REMOTE / NO C2C)

    Amerit Consulting • Bakersfield, CA, US
    Remote
    Permanent
    Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished.EPIC COGITO & RADAR A...Show more
    Last updated: 8 days ago • Promoted
    Qualified Moms Wanted : Healthy Prior Delivery + Age 21–36 (Surrogacy $50k–$100k)

    Qualified Moms Wanted : Healthy Prior Delivery + Age 21–36 (Surrogacy $50k–$100k)

    Ivy Surrogacy • Richgrove, CA, US
    Full-time +1
    Becoming a surrogate mother is one of the greatest gifts of life!.Ivy Surrogacy is a third-party reproductive agency for parents all over the world seeking. At Ivy Surrogacy, we genuinely believe we...Show more
    Last updated: 11 days ago • Promoted
    Had a Healthy Pregnancy? Earn $50k–$100k as an Ivy Surrogate

    Had a Healthy Pregnancy? Earn $50k–$100k as an Ivy Surrogate

    Ivy Surrogacy • Richgrove, CA, US
    Full-time +1
    Becoming a surrogate mother is one of the greatest gifts of life!.Ivy Surrogacy is a third-party reproductive agency for parents all over the world seeking. At Ivy Surrogacy, we genuinely believe we...Show more
    Last updated: 11 days ago • Promoted
    Fully Remote Survey Participant

    Fully Remote Survey Participant

    Prime Insights • Bakersfield, CA, US
    Remote
    Full-time
    Join thousands of members already earning with top-paying surveys and offers.Get started today and enjoy competitive rewards, fast payouts with no waiting periods, and the flexibility to participat...Show more
    Last updated: 26 days ago • Promoted
    Clinical Launch Innovator

    Clinical Launch Innovator

    Atraverse Medical, Inc. • Bakersfield, CA, US
    Full-time
    Atraverse Medical is developing the next generation of left-heart access technologies to streamline procedures and improve patient outcomes. You will be responsible for leading the field clinical fu...Show more
    Last updated: 30+ days ago • Promoted
    Sr. Power BI Developer

    Sr. Power BI Developer

    Herbalife • Bakersfield, CA, US
    Full-time
    This role is tasked with crafting, developing, and maintaining advanced Power BI solutions that transform sophisticated data into actionable insights. The Developer III, Power BI will work closely w...Show more
    Last updated: 10 days ago • Promoted
    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    OCPA • Richgrove, California, us
    Remote
    Part-time +1
    Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies. We guarantee 15-25 hours per week with an hourly pay of bet...Show more
    Last updated: 30+ days ago • Promoted
    Medical Auditor

    Medical Auditor

    LHH • Bakersfield, CA, US
    Full-time
    Health Information Management Auditor / Coder (Remote – HI, CA, WA, OR).Schedule : Full time, Monday thru Friday 8am-4 : 30pm Hawaiian Standard Time. Are you an experienced medical coder and auditor look...Show more
    Last updated: 12 days ago • Promoted
    Remote M&A Associate - AI Trainer ($50-$60 / hour)

    Remote M&A Associate - AI Trainer ($50-$60 / hour)

    Data Annotation • Bakersfield, California
    Remote
    Full-time +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...Show more
    Last updated: 19 days ago • Promoted
    Hematology Oncology Full Time Opportunity

    Hematology Oncology Full Time Opportunity

    Kaiser Permanente – Southern California Permanente Medical Group • Bakersfield, US
    Full-time +1
    Location : Bakersfield, CA - 2620 Chester Medical Offices - 2620 Chester Ave.Potential Premium Earnings : $23,328.Salary range includes incentives that are contingent upon skills, competencies, longe...Show more
    Last updated: 30+ days ago • Promoted
    Certified Peer Recovery Coach - Mental Health 633

    Certified Peer Recovery Coach - Mental Health 633

    Telecare Corporation • Bakersfield, CA, United States
    Full-time +1
    We have over 300 Peer roles at Telecare.We value this lived experience and this is what we are trying to grow within the organization. We have a career ladder specific to our Peer Workforce.What You...Show more
    Last updated: 10 days ago • Promoted
    Remote Equity / Option Trader

    Remote Equity / Option Trader

    Maverick Currencies • Bakersfield, CA
    Remote
    Full-time +1
    Top-ranked proprietary trading firm, Maverick Currencies, is searching for entrepreneurially-minded, profit-driven people to be trained in the art and science of proprietary trading in its online c...Show more
    Last updated: 30+ days ago • Promoted
    Remote Finance / Stock Trader Job in Bakersfield, CA | Full Time

    Remote Finance / Stock Trader Job in Bakersfield, CA | Full Time

    Maverick Currencies • Bakersfield, CA
    Remote
    Full-time +1
    Top-ranked proprietary trading firm, Maverick Currencies, is searching for entrepreneurially-minded, profit-driven people to be trained in the art and science of proprietary trading in its online c...Show more
    Last updated: 21 days ago • Promoted
    Stock / Options Trader - Remote

    Stock / Options Trader - Remote

    Maverick Currencies • Bakersfield, CA
    Remote
    Full-time +1
    Top-ranked proprietary trading firm, Maverick Currencies, is searching for entrepreneurially-minded, profit-driven people to be trained in the art and science of proprietary trading in its online c...Show more
    Last updated: 30+ days ago • Promoted
    Certified Medical Coder

    Certified Medical Coder

    Medix • Bakersfield, CA, US
    Full-time
    Per Diem | Certified Coding Specialist.Coding Department and play a key role in ensuring real-time accuracy and compliance in inpatient documentation and coding. This position works closely with the...Show more
    Last updated: 18 days ago • Promoted
    ERP Analyst I - Remote (One or More Positions)

    ERP Analyst I - Remote (One or More Positions)

    Kern Community College District • Bakersfield, CA, United States
    Remote
    Full-time
    ERP Analyst I - Remote (One or More Positions).Kern Community College District.Information Technology Services.Under the direction of the assigned supervisor, participate in a variety of specialize...Show more
    Last updated: 17 days ago • Promoted
    Remote Financial Advising Expert - AI Trainer ($50-$60 / hour)

    Remote Financial Advising Expert - AI Trainer ($50-$60 / hour)

    Data Annotation • Bakersfield, California
    Remote
    Full-time +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...Show more
    Last updated: 19 days ago • Promoted
    Claims Examiner I

    Claims Examiner I

    Astiva Health, Inc • Bakersfield, CA, US
    Full-time
    Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...Show more
    Last updated: 16 days ago • Promoted