Southern Illinois Healthcare
Clinical Compliance Auditor
Southern Illinois Healthcare, Herrin, Illinois, United States, 62948
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Position Summary
Responsible for performing appraisal and associated activities, including quality and compliance reviews, research and investigations of physician coding, documentation, and billing practices for adherence to policies, regulations, and best practices.
Principal Accountabilities
Standards of Performance: Respect, Integrity, Compassion, Collaboration, Stewardship, Accountability, Quality
Education
Bachelor's degree, RN, RHIT, or RHIA
In lieu of degree, 8 years of experience in auditing, coding, compliance or related field experience. Must have knowledge of physician documentation practices, CPT/HCPCS codes and modifiers, and healthcare regulations and enforcement. Experience working collaboratively with physicians and providing education is preferred. Knowledge of Rural Health Clinic regulation is a plus.
Licenses and Certification
Professional coding certification
Experience and Skills
Technical Experience: 3 years
Role Specific Responsibilities
Audits and investigations focus on detecting and preventing fraud and abuse.
Provides feedback and education after audits and investigations regarding any identified coding, documentation, or billing issues.
Support the development of corrective actions for deficiencies and the identification, quantification, and refund of any overpayments.
Responds to inquiries from patients, physicians' management and staff.
Conducts trend analysis.
Reviews requests from government agencies, payors, and patients.
Conducts research and provides education for documentation, coding, and billing issues and practices within the medical group.
Collaborates with clinic managers, regional directors, coding, PFS, and IT to design and implement improvements to enhance compliance with policies and regulations.
Performs evaluation and management and other specialized training, new provider orientation, and refresher training for staff and providers.
Evaluates the effectiveness of education and response to audit recommendations.
Research, interprets and communicates regulatory information and recommendations in various formats, including a compliance newsletter.
Maintains knowledge of current trends and developments within areas of expertise through research and continuing education and shares learning.
Identifies areas of risk within the Medical group for development of audit plans, the departments audit workplan, and education.
Protects confidentiality and acts collaboratively to build relationships within the organization.
Compensation (Commensurate with experience):
$66,144.00 - $102,523.20
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Position Summary
Responsible for performing appraisal and associated activities, including quality and compliance reviews, research and investigations of physician coding, documentation, and billing practices for adherence to policies, regulations, and best practices.
Principal Accountabilities
Standards of Performance: Respect, Integrity, Compassion, Collaboration, Stewardship, Accountability, Quality
Education
Bachelor's degree, RN, RHIT, or RHIA
In lieu of degree, 8 years of experience in auditing, coding, compliance or related field experience. Must have knowledge of physician documentation practices, CPT/HCPCS codes and modifiers, and healthcare regulations and enforcement. Experience working collaboratively with physicians and providing education is preferred. Knowledge of Rural Health Clinic regulation is a plus.
Licenses and Certification
Professional coding certification
Experience and Skills
Technical Experience: 3 years
Role Specific Responsibilities
Audits and investigations focus on detecting and preventing fraud and abuse.
Provides feedback and education after audits and investigations regarding any identified coding, documentation, or billing issues.
Support the development of corrective actions for deficiencies and the identification, quantification, and refund of any overpayments.
Responds to inquiries from patients, physicians' management and staff.
Conducts trend analysis.
Reviews requests from government agencies, payors, and patients.
Conducts research and provides education for documentation, coding, and billing issues and practices within the medical group.
Collaborates with clinic managers, regional directors, coding, PFS, and IT to design and implement improvements to enhance compliance with policies and regulations.
Performs evaluation and management and other specialized training, new provider orientation, and refresher training for staff and providers.
Evaluates the effectiveness of education and response to audit recommendations.
Research, interprets and communicates regulatory information and recommendations in various formats, including a compliance newsletter.
Maintains knowledge of current trends and developments within areas of expertise through research and continuing education and shares learning.
Identifies areas of risk within the Medical group for development of audit plans, the departments audit workplan, and education.
Protects confidentiality and acts collaboratively to build relationships within the organization.
Compensation (Commensurate with experience):
$66,144.00 - $102,523.20
#J-18808-Ljbffr