Medical Group Compliance Auditor Senior

Medical Group Compliance Auditor Senior

The Medical Group Compliance Auditor Senior is responsible for providing audit, coding support, and guidance to physicians, APPs, residents, and support staff. This role ensures that all coding, billing, and documentation complies with federal and/or state regulations, private payer health care program requirements, as well as the Compliance and Operations Policies of the organization. This job assists with the development and implementation of educational and training programs as well as coding tools and resources to help achieve the organizations goal of consistent, complete, and accurate coding and documentation.

Conducts regularly scheduled compliance reviews for assigned providers within designated time frames. Performs reviews of clinical documentation to verify accuracy of CPT/HCPSC and ICD.10 codes and modifier assignments. Provides written report of findings to the provider and select administrative personnel along with recommendations for improvement. Monitors regulatory and reimbursement information to keep informed of relevant changes and updates. Performs special demand audits as requested or noted in compliance or audit work plans program. Educates providers one-on-one or in a group setting based on need or as a result of an audit. Provides oversight and quality assessment of audit and other work of Medical Group Compliance Auditors as well as peers. Maintains effective communication with department staff as well as key stakeholders and consistently demonstrates high standards of professional conduct and ethics, as well as appropriate judgment, independence, and discretion. Performs other duties as assigned.

Required: High School Diploma or equivalent

Required: 5 years

Required: One of the following: Certified Professional Coder (CPC) or Certified Coding Specialist (Physician-based) (CCS-P). Preferred: Any additional certifications such as Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA).

Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills, and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities, and each other.