Compliance Analyst (Remote) - Billing Compliance and Audit

Auditor Position

Position is responsible for conducting comprehensive and focused audits in a variety of WashU Medicine multi-disciplinary clinical practices. The purpose of the audits is to determine accuracy of coding, documentation, and physician / provider compliance with CPT and ICD-10-CM coding standards, governmental billing regulations, and University policy. The position is responsible for analysis and interpretation of audit data resulting in communication of audit findings through written report.

Primary Duties & Responsibilities :

• Perform audit function of the WashU Medicine Office of Physician Billing Compliance (OPBC).
• Follow audit plan / schedule as outlined in the OPBC fiscal year work plan as approved by the Compliance Director.
• Identify and select audit sample via Epic billing system query and secure selected medical records from inpatient and outpatient locations.
• Review medical record documentation for compliance with CPT and ICD-10-CM coding standards, University policy and Center for Medicare and Medicaid Services (CMS) regulations, including regulation applicable to physicians in teaching hospitals.
• Analyze and interpret the data collected.
• Research issues that arise out of audit findings.
• Prepare reports, as required, to provide an analysis of the data collected and to inform physicians, departmental staff and / or compliance personnel of findings.
• Report issues of non-compliance identified through the audit process to the Compliance Audit Manager.
• Create and / or modify all auditing tools and aids to ensure compliance, including modifications necessary to reflect changes in regulations as they occur.
• Research specialty specific coding / billing issues prior to departmental / divisional audits and keep abreast of current specialty-specific coding literature and changes in regulation, standard coding practice and policy.
• Notify compliance educator(s) of department / division specific practices, policies and procedures that may affect and / or raise compliance issues identified during the audit process.
• Ensure audit protocol adheres to the Standards of Ethical Coding as set forth by the American Health Information Management Association and to official coding guidelines.
• Perform special audit and compliance-related projects as assigned.

Working Conditions :

Equipment :

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications :

More About This Job :

WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.

Preferred Qualifications :

Grade : C13

Salary Range : $68,100.00 - $105,500.00 / Annually

The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.