Heritage Health – Idaho Hiring for Compliance Auditor at Coeur D Alene Full Time

Description:

The Compliance Auditor will perform compliance audits for providers and the billing team. The Compliance Auditor will review medical record documentation to determine accuracy of assigned CPT, ICD-10-CM, HCPCS, and modifiers. The Compliance Auditor is a professional level position working in Compliance and with all levels of the organization. In this role you will have the ability to develop skills and gain experience working on a wide range of regulatory compliance topics, under direction of the Compliance Program management. This is a great opportunity for someone with a strong desire to learn, and who wants to further develop their skills in the healthcare compliance realm.

Requirements:

· Minimum 2-3 years’ work experience with completion of a certified coding program, (CPC, CCS, CCS-P, RHIA, RHIT)

· CRC or risk adjustment coding knowledge/experience preferred

· AAPC or AHIMA auditing credentials (CPMA, CDEO, CDIP) or commitment to start process for certification within first 6 months of employment

· Experience in a primary care setting (FQHC/RHC/CBHC experience preferred)

· Behavioral health coding/auditing experience (Preferred)

· Minimum 1 year conducting provider/coder education and/or audits (4-5 years preferred)

· Current knowledge of CPT, ICD-10-CM, HCPCs, and modifiers

· Understanding of medical terminology and anatomy

· Experience working with Medicare, Medicaid, and private payers

· Investigative and research skills

· The desire to learn and the desire to teach are fundamental to the success in this role

Key Success Factors:

· Excellent verbal and written communication skills, including Microsoft Suite

· Proficient in billing and coding requirements for federal and private payers

· Self-motivated, with a desire to enhance coding and compliance skills and knowledge

· Excellent organizational skills and attention to detail

· Exceptional time management, priority setting skills, and ability to multi-task

· Proven problem-solving skills

· Ability to understand copious amounts of information and distill it down to the key facts

· Service oriented to consistently engage and build relationships at all levels of the organization

· Ability to recognize and assess sensitive situations and compliance matters understanding the need to support confidentiality, and work to resolve issues in a timely manner

Essential Functions:

· Performs provider audits to ensure accuracy of CPT, ICD-10, HCPCS, and modifiers reported.

· Performs quality audits of billing team in the event of a coding change, to ensure compliance with coding guidelines and company policies for complete, accurate, and consistent coding

· Act as a coding and compliance resource for staff member questions

· Stay current on, and communicate, changes in coding rules and regulations

· Responsible for researching, reviewing, and interpreting federal and state regulations

· Assist with creating, maintaining, and delivering education content to providers and billers to support documentation improvement as needed.

· Assist with supporting the Heritage Health Compliance Program to include policies & procedures, HIPAA privacy rules, and participating on projects or investigations

· Travel to and from Heritage Health sites to participate in training, projects, or investigations.

· Commitment to professional growth and understanding of the changing environment through current events reading, continuing education, self study, cross-functional training, and work assignment variation.

· Remain current on certifications and coding compliance rules and regulations

· Other duties as assigned

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