Compliance Auditor - Pensacola - Baptist Health Care

    Baptist Health Care
    Baptist Health Care Pensacola

    18 hours ago

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    Description

    Compliance Auditor - Hospital IP/OP

    This role is responsible for auditing inpatient claims to federally funded healthcare payors across all Baptist Health Care (BHC) inpatient facilities. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and notes trends.

    The Compliance Auditor - Hospital IP/OP educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; accurately reflects mortality; and maximizes reimbursement.

    This position requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards.

    Responsibilities

    • Audits inpatient (IP) service claims to assure a minimum of 95% accuracy and recommends corrective action, education, and training related to audit results.
    • Reviews and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided.
    • Develops and maintains comprehensive audit reports and documentation of each audit performed, cases sampled, and audit findings.
    • Presents audit findings and required remediation/corrective actions to cure coding and billing errors to audited providers/department leadership.
    • Provides information to physicians and other health care staff regarding current coding practices and changes in state and federal regulations and guidelines.
    • Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes.
    • Maintains responsibility for operational excellence and ensures the delivery of quality audit services in accordance with applicable policies, procedures, and professional standards.

    Qualifications

    • Bachelor's Degree in Health Information Management or a related field (Five years of related experience maybe considered in lieu of degree)
    • 5 years of health care compliance experience including coding compliance
    • 3 years of health care compliance auditing of coding and billing practices
    • Certified Coding Specialist (CCS_AHIMA), Certified Coding Specialist-Physician-based (CCSP_AHIMA), Certified Professional Coder (CPC_AAPC), Certified Outpatient Coding (COC_AAPC), or Certified Professional Medical Auditor (CPMA_AAPC) certification

    The ideal candidate will have strong knowledge of ICD-10/PCS/CPT/HCPCS coding and billing compliance, excellent analytical and data mining skills, and the ability to effectively communicate with various levels of staff.

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