Talent.com
Compliance Coding Auditor, ATM
Compliance Coding Auditor, ATMAdvanced Medical Management • Long Beach, CA, US
Compliance Coding Auditor, ATM

Compliance Coding Auditor, ATM

Advanced Medical Management • Long Beach, CA, US
5 days ago
Job type
  • Full-time
Job description

Job Description

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 • Long Beach, CA, US

    Related jobs
    Senior Compliance Associate

    Senior Compliance Associate

    VirtualVocations • Signal Hill, California, United States
    Full-time
    A company is looking for a Senior Compliance Associate to assist with compliance programs in Funds and Investments Compliance. Key Responsibilities Monitor and update compliance policies and proce...Show more
    Last updated: 4 days ago • Promoted
    ISO 27001 Auditor

    ISO 27001 Auditor

    VirtualVocations • Long Beach, California, United States
    Full-time
    A company is looking for a Staff ISO 27001 Auditor - LATAM.Key Responsibilities Perform day-to-day activities of IT audit engagements and readiness assessments Evaluate the design and effectiven...Show more
    Last updated: 1 day ago • Promoted
    Audit and Appeal Specialist

    Audit and Appeal Specialist

    University of California - Los Angeles Health • Los Angeles, CA, United States
    Full-time
    Contribute to the success of a world-class healthcare organization by ensuring compliance in regulatory audits and appeals. Leverage your expertise to support UCLA Health's commitment to accuracy an...Show more
    Last updated: 15 days ago • Promoted
    Audit Letter Analyst

    Audit Letter Analyst

    Cooley LLP • Santa Monica, CA, United States
    Full-time
    CooleyisseekinganAuditLetterAnalysttojointheRisk&Complianceteam.Under the direction of the Audit Team Letter Manager, the Audit Letter Analyst will work with attorneys to respond to and monitor aud...Show more
    Last updated: 30+ days ago • Promoted
    Compliance Analyst

    Compliance Analyst

    Mannara Technologies Pvt. Ltd. • Newport Beach, CA, US
    Temporary
    Job Title : Compliance Analyst III.Location : Newport Beach, CA 92660.Duration : 6 months Contract (Good Possibilities of extension). How you’ll help move us forward : .Provide compliance support t...Show more
    Last updated: 1 day ago • Promoted
    Compliance Specialist - LIHTC

    Compliance Specialist - LIHTC

    VirtualVocations • Carson, California, United States
    Full-time
    A company is looking for a Compliance Specialist focused on Affordable Housing.Key Responsibilities Deliver outstanding customer service to onsite teams during the file approval process Review r...Show more
    Last updated: 1 day ago • Promoted
    North Carolina Licensed Compliance Specialist

    North Carolina Licensed Compliance Specialist

    VirtualVocations • Long Beach, California, United States
    Full-time
    A company is looking for a Compliance Specialist (NC Remote).Key Responsibilities Execute the consumer complaint resolution process and manage complaint logs Review and resolve consumer disputes...Show more
    Last updated: 5 days ago • Promoted
    Insurance Verification Specialist

    Insurance Verification Specialist

    TEKsystems • San Pedro, CA, United States
    Full-time
    Job Title : •Insurance Verification Specialist.Location : • San Pedro, CA 90732.Sub Acute : Monday - Friday, 8 : 30 AM - 5 : 00 PM. ED : Start time between 2 : 00 PM - 4 : 00 PM (8-hour shift) with alternating w...Show more
    Last updated: 2 days ago • Promoted
    Audit Senior - Remote - Home Based - Hybrid Schedule Available!

    Audit Senior - Remote - Home Based - Hybrid Schedule Available!

    US Main • Los Angeles, CA, US
    Remote
    Full-time
    Audit Senior - Assurance and Advisory Services - Remote - Home Based / Hybrid Schedule Avaialble Well established, highly profitable regional CPA firm seeks an Audit Senior to specialize in excitin...Show more
    Last updated: 4 days ago • Promoted
    Premium Audit Technician

    Premium Audit Technician

    VirtualVocations • Glendale, California, United States
    Full-time
    A company is looking for a Premium Audit Processing Technician.Key Responsibilities Process audits for various lines of business including Workers' Compensation and General Liability Manage assi...Show more
    Last updated: 30+ days ago • Promoted
    California Licensed Audit Reviewer

    California Licensed Audit Reviewer

    VirtualVocations • Pasadena, California, United States
    Full-time
    A company is looking for an Audit Reviewer for Premium Insurance.Key Responsibilities Review and validate Workers' Compensation and General Liability audits for accuracy and compliance Identify ...Show more
    Last updated: 4 days ago • Promoted
    Florida Licensed Compliance Specialist

    Florida Licensed Compliance Specialist

    VirtualVocations • Norwalk, California, United States
    Full-time
    A company is looking for a Compliance Specialist (FL Remote).Key Responsibilities Execute the consumer complaint resolution process and manage complaint logs Review and investigate consumer disp...Show more
    Last updated: 5 days ago • Promoted
    Audit Analyst

    Audit Analyst

    Hinderliter de Llamas & Associates • Brea, California, US
    Full-time
    The HdL Companies help cities, counties and special districts maximize revenues through research and discovery efforts, financial and economic analysis, and provision of software that supports loca...Show more
    Last updated: 1 day ago • Promoted
    Regional Compliance Auditor

    Regional Compliance Auditor

    Spread Your Wings Inc • Garden Grove, CA, United States
    Full-time
    Come Join our new Regional Team!.This position is not remote based but requires travel and occasional overnight stay to a Southern California location. Southern California - This position can be bas...Show more
    Last updated: 1 day ago • Promoted
    Claims Auditor

    Claims Auditor

    AltaMed • Montebello, CA, US
    Full-time
    If you are as passionate about helping those in need as you are about growing your career, consider AltaMed.At AltaMed, your passion for helping others isn't just welcomed it's nurtured, celebrate...Show more
    Last updated: 30+ days ago • Promoted
    CRA Analyst

    CRA Analyst

    Cathay Bank - Headquarters • El Monte, CA, United States
    Full-time
    Are you enthusiastic, highly motivated, and have a strong work ethic? If yes, come join our team! At Cathay Bank - we strive to provide a caring culture that supports your aspirations and success....Show more
    Last updated: 30+ days ago • Promoted
    Claims Auditor

    Claims Auditor

    Health Source MSO • Alhambra, CA, US
    Full-time
    Job Description : Claims Auditor will be responsible for auditing claims processed by Claims Examiners.Responsibilities include, but not limited to : Maintain up-to-date knowledge of procedures for a...Show more
    Last updated: 30+ days ago • Promoted
    Financial Compliance Auditor III Claims

    Financial Compliance Auditor III Claims

    L.A. Care Health Plan • Los Angeles, CA, United States
    Full-time
    Financial Compliance Auditor III Claims.Job Category : Accounting / Finance.Department : Financial Compliance.Care Health Plan is an independent public agency created by the state of California to prov...Show more
    Last updated: 1 day ago • Promoted