Compliance Auditor Senior - Healthcare Legal and Regulatory (Eastern United States resident)
Job Summary
The Senior Compliance Auditor ensures the integrity and accuracy of facility and professional compliance audits, monitoring, and provides compliance education for facility and professional documentation, coding, and billing. The Senior Compliance Auditor serves as a mentor for Compliance Auditors and assists management with the onboarding process for new Compliance Auditors. This position requires the use of judgement and critical thinking skills to determine appropriate corrective actions for non-compliance and ensure corrective actions are fully implemented by the entity service line area.
Job Duties
One of the following coding or auditing certifications are required (CCS, CPC, RHIA, RHIT or CPMA).
- Performs scheduled facility and/or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD 10) and billing as required by the Compliance work plan reflecting scheduled activities and target dates.
- Performs audits resulting from unplanned investigations.
- Q/A work products of peers and serve as a mentor for compliance staff.
- Serves as primary lead for facility/professional billing compliance education, including auditing, trending, providing audit feedback to facility/professional coding staff and providers working in the hospital and office setting.
- Coordinates the development and implementation of corrective action and improvement plans with critical attention to performing a root cause analysis.
- Prepares responses to governmental audits, evaluate findings, and manage the appeals process.
- Assess compliance risk areas across Geisinger entities and assist with creating the Compliance Department’s work plan.
- Performs research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
- Provides compliance guidance to Geisinger staff and serve as an institutional resource for Geisinger leadership, management and medical staff with a focus on federal payor billing compliance.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
#LI-REMOTE
Education
Associate's Degree-Related Field of Study (Required)Experience
Minimum of 7 years-Related work experience (Required)Skills
Problem Solving; Communication; Training and Education; Critical Thinking; Medical Billing and Coding; OrganizingAbout Geisinger
Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.
Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Our Vision & Values
Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.
KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
EXCELLENCE: We treasure colleagues who humbly strive for excellence.
LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
Our Benefits
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.
“I’ve been surprised by the community our floor has even though we can all work different days and different shifts. We celebrate successes and life events for employees and patients — that’s what makes it a fun place to work!”
Nurse Assistant
A place where you can lead a healthy lifestyle and follow your dreams.
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