Staff Coding Compliance Auditor, Medical Billing and Coding

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October 17

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

⏰ Full Time

🔴 Lead

🔎 Auditor

🦅 H1B Visa Sponsor

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Geisinger

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Healthcare • Pharmaceuticals • Wellness

Geisinger is a healthcare organization that has been providing accessible medical services for over a century in Pennsylvania. It focuses on meeting the healthcare needs of its communities and is dedicated to innovative patient care. With career opportunities in various fields including nursing, allied health, and administration, Geisinger promotes professional development and a supportive workplace for its employees, emphasizing diversity, equity, and inclusion.

10,000+ employees

Founded 1915

💊 Pharmaceuticals

🧘 Wellness

📋 Description

• The Compliance Auditor position is responsible for supporting the organization’s Revenue Management Compliance department in developing, implementing, and administering an effective compliance program • Accurately audits and provides compliance research support to physicians, non-physician practitioners, leadership, and administrative staff on documentation and coding requirements • Determines the adequacy of medical record documentation, coding, and billing, using established compliance auditing and research guidelines for hospital and professional services • Performs compliance audits to determine the adequacy of medical record documentation, billing, and coding, utilizing policies, procedures, Federal and State laws, regulations, and standard coding guidelines • Evaluates whether documentation and coding patterns present a compliance risk to the organization and provides input on recommended solutions • Identifies training and education needs through compliance audit results prepared and partners with peers to educate physicians and non-physician practitioners • Serves as a clinical coding subject matter expert for multiple assigned specialties and utilizes critical thinking when evaluating matters potentially impacting compliance • Works closely with revenue cycle staff to review systems and/or workflows established to ensure compliance with policies, plans, procedures, laws and regulations • Reviews service line operations or programs to ascertain whether audit results are consistent with established policies, procedures, procedures, Federal and State regulations • Identifies and defines audit scope and criteria and program of examination for the assigned areas being audited • Responsible for surveying the functions and activities in the assigned areas being audited to determine the nature of operations and adequacy of the system to achieve established objectives • Identifies key control points of assigned areas being audited • Obtains, analyzes, and appraises evidentiary data and available information as a basis for making an informed, objective opinion on the adequacy and effectiveness of systems and the performance of assigned areas being audited • Makes recommendations for improvement and corrective action plans where appropriate • Prepares accurate executive briefs showing the results of assigned areas being audited in accordance with those practices followed within the general scope of the audit parameters • Appraises the adequacy of corrective action taken by management to address findings identified through an external audit engagement • Provides input in the risk assessment process to determine specific areas of focus for compliance risk mitigation as directed by Compliance or Senior Leadership • Work is typically performed in an office environment

🎯 Requirements

• Minimum one Coding Certification required: --Certified Professional Coder - AAPC • --Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC) • --Registered Health Information Technician (RHIT) - American Health Information Management Association • High School Diploma or Equivalent (GED)- (Required) • Minimum of 6 years-Relevant experience* (Required)

🏖️ Benefits

• healthcare benefits for full time and part time positions from day one • vision, dental and domestic partners • atmosphere of collaboration, cooperation and collegiality