Medical Group Compliance Auditor Senior - HYBRID

The Medical Group Compliance Auditor Senior is responsible for providing audit, coding support and guidance to physicians, APPs, residents and support staff. This role ensures that all coding, billing and documentation complies with federal and / or state regulations, private payer health care program requirements as well as the Compliance and Operations Policies of the organization. This job assists with the development and implementation of educational and training programs as well as coding tools and resources to help achieve organization's goal of consistent, complete and accurate coding and documentation.

Capable of working independently to conduct regularly scheduled compliance reviews for assigned providers, practices, and focused review areas within designated time frames.

Provides mentorship and guidance to the more junior Medical Group Compliance Auditor during the audit completion process.

Performs Reviews clinical documentation to verify accuracy of CPT / HCPSC and ICD.10 codes and modifier assignments.

Provides written report of findings to the provider and select administrative personnel along with recommendations for improvement.

Monitors regulatory and reimbursement information to keep informed of relevant changes and updates.

Performs special demand audits as requested or noted in compliance or audit work plans program.

Educates providers one-on-one or in a group setting based on need or as a result of an audit.

Provides oversight and quality assessment of audit and other work of Medical Group Compliance Auditors as well as peers.

Maintains effective communication with department staff as well as key stakeholders and consistently demonstrates high standards of professional conduct and ethics, as well as appropriate judgment, independence, and discretion.

Performs other duties as assigned.

EDUCATION :

Required : Bachelor's Degree, required; or Associates Degree, required with 5 years of auditing experience.

EXPERIENCE :

Required : 5 years of professional coding experience with a minimum of two years auditing experience for coding compliance / accuracy, with Bachelor's Degree

LICENSURE / CERTIFICATION / REGISTRY / LISTING :

Required : One of the following : Certified Professional Coder (CPC) or Certified Coding Specialist (Physician-based) (CCS-P).

Preferred : Any additional certifications such as Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA).

Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.