Talent.com
Compliance Coding Auditor for the Auditing, Tracking, and Monitoring

Compliance Coding Auditor for the Auditing, Tracking, and Monitoring

Advanced Medical Management, Inc.San Diego, CA, United States
2 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 • San Diego, CA, United States

    Related jobs
    • Promoted
    Customs and Border Protection Officer - Experienced - Location incentives

    Customs and Border Protection Officer - Experienced - Location incentives

    U.S. Customs and Border ProtectionTecate, CA
    Full-time
    Customs and Border Protection Officer (CBPO).Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of high...Show moreLast updated: 30+ days ago
    • Promoted
    Customs and Border Protection Officer - Experienced

    Customs and Border Protection Officer - Experienced

    U.S. Customs and Border ProtectionTecate, CA, United States
    Full-time
    Customs and Border Protection Officer (CBPO).Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of high...Show moreLast updated: 30+ days ago
    • Promoted
    Share Your Thoughts, Pocket Some Cash : Join Opinion Outpost's Survey Opportunities!

    Share Your Thoughts, Pocket Some Cash : Join Opinion Outpost's Survey Opportunities!

    DynataAlpine, CA, US
    Full-time
    Ready to turn your opinions into cash? Explore the world of remote paid online survey gigs with Opinion Outpost!.It's as simple as sharing your thoughts from the comfort of your own home and watchi...Show moreLast updated: 2 days ago
    • Promoted
    Customs and Border Protection Officer - Entry Level

    Customs and Border Protection Officer - Entry Level

    U.S. Customs and Border ProtectionTecate, CA, United States
    Full-time
    Customs and Border Protection Officer (CBPO).Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of high...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Customs and Border Protection Officer

    Customs and Border Protection Officer

    U.S. Customs and Border ProtectionPine Valley, CA, US
    Full-time
    Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of highly trained professionals whose camaraderie, p...Show moreLast updated: 4 hours ago
    • Promoted
    Online Jobs - Earn Up to $1,500 a Month

    Online Jobs - Earn Up to $1,500 a Month

    Free Cash by AlmediaAlpine, CA, US
    Full-time
    Receive a $5 welcome bonus when you complete your first offer!Make money in your spare time by completing online tasks : . Take paid surveys (5-15 minutes each).Test new mobile games and apps.Share yo...Show moreLast updated: 2 days ago
    • Promoted
    Fully Remote Survey Participant

    Fully Remote Survey Participant

    Prime InsightsAlpine, 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 moreLast updated: 2 days ago
    • Promoted
    Take Surveys Get Paid!

    Take Surveys Get Paid!

    Prime InsightsAlpine, CA, US
    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 moreLast updated: 2 days ago
    Financial Compliance Auditor : 25-05150

    Financial Compliance Auditor : 25-05150

    Akraya IncSan Diego, California, United States
    Full-time
    Quick Apply
    Primary Skills : Auditing-Advanced, Excel-Intermediate, Analysis-Advanced, Documentation-Intermediate, Compliance-Advanced. Location : Atlanta, GA / San Diego / Mountain view, CA(#LI-HYBRID).We are seekin...Show moreLast updated: 30+ days ago
    • Promoted
    Customs and Border Protection Officer - Entry Level - Location incentives

    Customs and Border Protection Officer - Entry Level - Location incentives

    U.S. Customs and Border ProtectionTecate, CA
    Full-time
    Customs and Border Protection Officer (CBPO).Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of high...Show moreLast updated: 30+ days ago
    • Promoted
    Flexible Online Job – Earn Up to $1,500 / Month Playing Mobile Games

    Flexible Online Job – Earn Up to $1,500 / Month Playing Mobile Games

    Free Cash by AlmediaAlpine, CA, US
    Full-time
    Receive a $5 welcome bonus when you complete your first offer!Make money in your spare time by completing online tasks : . Take paid surveys (5-15 minutes each).Test new mobile games and apps.Share yo...Show moreLast updated: 2 days ago
    • Promoted
    Associate Independent Auditor

    Associate Independent Auditor

    Government JobsSan Diego, CA, US
    Full-time
    Independent Performance Auditor.San Diego Association of Governments.Office of the Independent Performance Auditor.SADAG Independent Performance Audit Function. On January 1, 2018, a new California ...Show moreLast updated: 30+ days ago
    • Promoted
    Air Interdiction Agent

    Air Interdiction Agent

    US Customs and Border ProtectionPotrero, CA, US
    Full-time
    Air and Marine Operations (AMO), a component of U.Customs and Border Protection (CBP), offers skilled Pilots interested in law enforcement an opportunity to work with an elite team of highly traine...Show moreLast updated: 30+ days ago
    • Promoted
    Earn Money Playing Games, Answering Surveys & Testing Apps

    Earn Money Playing Games, Answering Surveys & Testing Apps

    AttaPollAlpine, CA, US
    Full-time
    Get paid to answer surveys, play games, test apps, and do tasks.Make extra money on your phone and instantly cash out to PayPal, Revolut, or with gift cards from $3.Show moreLast updated: 2 days ago
    • Promoted
    • New!
    United States Customs and Border Protection Officer

    United States Customs and Border Protection Officer

    U.S. Customs and Border ProtectionPine Valley, CA, US
    Full-time
    Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of highly trained professionals whose camaraderie, p...Show moreLast updated: 4 hours ago
    • Promoted
    IRS Tax Controversy & Procedure Senior Associate

    IRS Tax Controversy & Procedure Senior Associate

    Eide BaillySolana Beach, CA, United States
    Full-time
    Rancho Cucamonga, CA; Tustin, CA; Torrance, CA; Irvine, CA; Long Beach, CA; Woodland Hills, CA; San Diego, CA; Solana Beach, CA. Pasadena, CA.A typical day as an IRS Tax Controversy Senior Associat...Show moreLast updated: 7 days ago
    • Promoted
    Border Patrol Agent - Entry Level - Up to 30k Sign On Bonus

    Border Patrol Agent - Entry Level - Up to 30k Sign On Bonus

    U.S. Customs and Border ProtectionAlpine, CA, United States
    Full-time
    Border Patrol Agent (BPA) GL-5 / 7 grade levels.IMPORTANT NOTICE : Duty assignments available at the time of offer may include the Southwest Border, including prioritized locations.Border Patrol deter...Show moreLast updated: 30+ days ago
    • Promoted
    Share Your Opinions. Earn Rewards.

    Share Your Opinions. Earn Rewards.

    Opinion EdgeAlpine, CA, US
    Full-time
    Join Opinion Edge today and get paid for your insights! Take short surveys on the topics that matter to you and earn rewards for every completed survey. Sign up now and start turning your voice into...Show moreLast updated: 2 days ago