Compliance Billing & Coding Auditor II

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Stanford Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1885

🏥 Healthcare

Healthcare

Stanford Health Care is a major academic medical center and integrated hospital system delivering comprehensive clinical care, specialty services, and patient support. The organization operates hospitals, outpatient clinics and programs, offers clinical trials and telehealth (video visits), and provides patient-facing services such as a MyHealth patient portal, billing/insurance assistance, and resources for referring physicians, nurses and allied health professionals. It also engages with the community through donations, visitor services, and COVID-19 resources.

📋 Description

• Initiate and perform proactive coding and billing audits before claims submission, and conduct 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 medical services and the accuracy of ICD, HCPCS, CPT, E&M, APC, DRG assignments, and charges • Review documentation supporting billed services and identify compliance risks through risk assessments • Conduct investigations and independent audits of facility and professional fee accounts for all patient types • Collaborate with relevant departments to gather information and evaluate documentation • Prepare audit and investigative reports with findings, corrective-action recommendations, and improvement areas • Monitor implementation and effectiveness of corrective actions • Provide feedback to Billing and Coding educators to improve training materials • Track federal, state, payer, healthcare regulations, and coding-guideline changes • Participate in compliance training and assist with developing training content for revenue cycle departments • 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/experience, required • Minimum four (4) years of progressively responsible directly related work experience required • CCS, CCS-P, CPC, CIC, or COC certification required within 180 days • EPIC EHR experience preferred • Knowledge of ICD-10-CM/PCS, HCPCS, E&M, CPT, DRG/APC reimbursement, and third-party payer rules • Knowledge of healthcare compliance audit requirements, principles, and techniques • Ability to plan, organize, and conduct detailed healthcare corporate compliance functions and audits • Ability to identify waste, fraud, abuse, and inefficiencies in conformance with laws, regulations, and standards • Ability to reach independent decisions, logical conclusions, and prepare reports of findings and recommendations • Knowledge of computer systems, specifically EPIC and 3M • Proficiency with Microsoft Word, Excel, and PowerPoint • Ability to manage priorities, multitask, adapt to changing priorities, communicate effectively, summarize data, and present results • Ability to provide leadership in problem identification and issue resolution • Ability to apply critical thinking, mediate, and solve complex work problems • Ability to facilitate work groups to successful outcomes • Ability to maintain confidentiality and current knowledge of healthcare compliance requirements, practices, and trends • Hospital and/or professional auditing experience in an Academic Medical Center preferred

🏖️ Benefits

• Remote work arrangement • Full-time employment • Day shift, 08-hour schedule • Professional development through compliance training sessions and workshops • Participation in developing compliance training content • Equal opportunity employment