Compliance Billing & Coding Auditor II
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Job Description
Healthcare compliance auditor reviewing billing, coding, documentation, and reimbursement accuracy for Stanford Health Care. Investigating discrepancies and recommending corrective actions to reduce compliance risks.
Responsibilities:
- 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
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