000708

JOB TITLE: Auditor Senior - Medical Compliance
CLASS CODE: 000708

JOB SUMMARY

Assist in the development and preparation of audit plans, programs, reports and participates in the audits of all medical units.

DUTIES & RESPONSIBILTIES

Assist in determining the overall direction of the audit plan, coordinate and conduct compliance audits concerning documentation and levels of services billed.

Analyze and prepare written reports on findings. Review system to determine effectiveness and make adjustments to the process as needed.

Provide training for clinicians and billing staff regarding medical record documentation regulations and levels of service coding.

Report results of audits to the Director and work with Director and Clinicians to address and resolve documentation and level of service deficiencies.

Appraise adequacy of corrective action taken to improve defiant conditions.

Maintain familiarity with third-party regulations regarding medical documentation for reimbursement of services provided by clinicians.

Directs, counsels, instructs and supervises staff auditors and review their work for efficiency and accuracy.

KNOWLEDGE, TRAINING & SKILLS

Bachelor's degree in a related field. Certified Procedural Coder (CPC) and/or Certified Professional Coder – Hospital (CPC-H) and/or Certified Coding Specialist – Physician Office Based (CCS-P) and/or Certified Coding Specialist (CCS) or become certified in one or more mentioned within 9 months of employment.  Maintain continuing education requirements if needed.

EXPERIENCE

Four years of related experience with experience in medical terminology, CPT and ICD-9 coding.  An equivalent combination of education, training and/or experience may be substituted for the requirements noted.