Sr. Physician Coding Compliance Auditor

What will I be doing in this role?

The Senior Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with, educates, and trains providers and staff on results, identifies issues and/or risks associated with documentation, coding and billing. Acts as a point of escalation for more complex inquiries and issues. In addition, the Senior Physician Compliance Auditor will also work closely with senior leadership on discovered irregularities, needed action items, and makes recommendations to address areas of opportunity. In this role your duties will include:

• Performing physician compliance audits to ensure accurate documentation and coding practices are maintained.
• Identifying areas of risk and/or non-compliance and provides recommendations for action - advances as needed.
• Conducting education and training sessions with individual providers on results, regulatory requirements and provide actionable feedback for improvement.
• Tracking, recording, and maintaining audit/review activity.
• Responding to complex billing, coding, and documentation inquires.
• Providing regular and ad hoc reporting
• Developing and revising education materials, conducting policy review, and ad hoc trainings.
• Assisting with risk analysis
• Assisting in training, onboarding, and mentoring new/less experienced team members.
• Assisting with audit & compliance related special projects as requested.

Requirements:

• High school diploma or GED required. Bachelor's degree preferred.
• A minimum of 5 years of experience reviewing chart documentation and coding/auditing physician professional services (preferably in a multi-specialty practice) required.
• A minimum of 3 years of experience with interpretation and communication of rules, regulation and guidelines at an expert level required.
• A minimum of 1 year of experience coding charts on an academic medical center required.