Healthcare Compliance Auditor – Healthcare Transaction & Strategy

Job Description: • Plan and perform medical record audits to determine coding accuracy and compliant claims submission • Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance • Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines • Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement • Serve as a subject matter expert on interpretation and application of coding and documentation guidelines • Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas • Stay current on coding guidelines • Develop analyses using transactional data and/or financial data • Generate client deliverables and make valuable contributions to expert reports • Manage client relationships and communicate results and work product as appropriate • Manage junior staff and delegate assignments as directed by more senior managers • Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions • Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting • Prioritize assignments and responsibilities to meet goals and deadlines Requirements: • An undergraduate degree (e.g., BS, BA) • Active coding certification from either AAPC or AHIMA is required • Preference will be given to candidates that are certified in medical auditing • 2+ years of work experience with a focus on healthcare provider billing and coding • 5-7 years of experience is required for the Managing Consultant level position • Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs) • Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation • Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements. • Required skills include: Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results. • Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word. • A desire to expand those capabilities is required, as is the ability to train others to use such tools. • Commitment to producing high quality analysis and attention to detail. • Excellent time management, organizational skills, and ability to prioritize work and meet deadlines. • Keen interest in healthcare compliance and healthcare policy. • Exceptional verbal and written communication skills. • Desire to work within a team environment. • Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship. Benefits: • Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities Apply tot his job