Compliance Billing & Coding Auditor II

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🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $52 - $69 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Stanford Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1885

🏥 Healthcare

⚕️ Healthcare Insurance

📚 Education

Healthcare • Healthcare Insurance • Education

Stanford Health Care is a major academic medical center affiliated with Stanford Medicine. It provides world-renowned patient care, emphasizes innovation and research, and offers a wide range of clinical services and career opportunities across nursing, advanced practice, allied health, laboratory, technology, administration, and other areas. The organization promotes values such as C-I-CARE (respect, courtesy, personal connection), sustainability, dedication, and community collaboration across physicians, researchers, professors, and students to advance health, healing, and knowledge globally.

📋 Description

• Initiate and perform proactive coding and billing audits before claims submission, with retrospective audits when required • Use auditing software and tools to streamline audits and improve data analysis • Monitor and analyze billing and coding data for errors and regulatory non-compliance • Evaluate ICD, HCPCS, CPT, E&M, APC, DRG assignments, charges, medical necessity, and reimbursement accuracy • Review documentation supporting billed services and conduct compliance risk assessments • Investigate billing and coding compliance issues, including independent audits of facility and professional fee accounts • Collaborate with departments to gather information and evaluate documentation • Prepare audit and investigative reports with findings and corrective-action recommendations • Monitor implementation and effectiveness of corrective actions • Provide feedback to Billing and Coding educators and assist with training content • Stay current on federal, state, payer, healthcare regulations, and coding guidelines • Assist educators in responding to compliance inquiries • Contribute to the Office of Compliance and Privacy’s Risk Assessment, Workplan, and strategic goals

🎯 Requirements

• Associate’s degree in a work-related discipline/field from an accredited college or university, or equivalent combination of education and experience • Minimum four (4) years of progressively responsible directly related work experience • EPIC EHR experience preferred • Ability to manage, organize, prioritize, multitask, and adapt to changing priorities • Effective written and verbal communication, including summarizing data and presenting results • Ability to lead problem identification and issue resolution • Ability to support arguments with data and apply critical thinking • Ability to mediate and solve complex work problems and issues • Ability to facilitate work groups to successful outcomes • Knowledge of ICD-10-CM/PCS, HCPCS, E&M, and CPT coding conventions • Knowledge of DRG/APC reimbursement and third-party payer rules and regulations • Knowledge of healthcare compliance audit requirements, principles, and techniques • Ability to conduct healthcare corporate compliance functions and audits and prepare findings reports • High standards of professional ethics, integrity, and trust • Ability to maintain confidentiality of sensitive information • Current knowledge of healthcare compliance requirements, practices, and trends • Knowledge of EPIC and 3M computer systems • Knowledge of Microsoft Word, Excel, and PowerPoint • CCS, CCS-P, CPC, CIC, or COC certification required within 180 days • CHC certification preferred • Hospital and/or professional auditing experience in an Academic Medical Center preferred • Candidates must adopt and execute Stanford Health Care’s C-I-CARE standards

🏖️ Benefits

• Remote work arrangement • Base pay of $52.69–$69.82 per hour • Opportunity to participate in compliance training sessions and workshops • Opportunity to contribute to the Office of Compliance and Privacy’s strategic goals