Physician Compliance Auditor – Professional Billing – Remote – Days

Job Description

Grady Health System offers many career paths for experienced professionals. Whether you have many years of experience or are in the early stages of your career, you can find a rewarding career at Grady!

Location : Atlanta, GA

Job Type : FTE

Shift/Schedule : Days

This is a remote role, but the ideal candidate will be required to come into the office occasionally to meet with the providers.

Summary

The Physician Compliance Auditor is responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes. The Compliance Auditor is responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, the appropriateness of treatment setting, HIPAA matters, and other compliance issues as directed by the Physician Coding Director, Compliance Director. 

This position requires effective communication with internal stakeholders and external auditors. Candidate should possess excellent organization skills to ensure accuracy and timeliness of audit results.

Assess the educational needs of physicians regarding coding and documentation and direct development of effective regularly scheduled educational programs that meet physician needs and serve as the primary resource to physicians for documentation and coding issues.

Responsible for conducting coding and billing training programs for billing and coding specialists and physicians. Creates presentations, develops learning material, handbook and other training materials. Conducts coding and data quality reviews and prepares complex reports as required. Ensures all Revenue Cycle coding activities comply with clinical billing standards and government regulation with concentration on hospital inpatient procedures and specialty physician services.

MINIMUM EDUCATION REQUIRED:

High School Diploma/GED required. Certified Professional Coder CPC, RHIA, RHIT, AAPC or AHIMA accredited preferred. Bachelors/Associates Degree preferred.

MINIMUM EXPERIENCE REQUIRED:

Five (5) years of coding experience required, with at least three (3) of those years in auditing.

ADDITIONAL PREFERRED QUALIFICATIONS:

One of the following CHC, CIA, CHA, CHIAP, CCS, CCA, CCS-P, or CPC-I certifications

KEY RESPONSIBILITIES:

1. Responsible for conducting compliance audits, reporting results, researching/investigating issues, and establishing compliance monitoring processes.

2. Serves as a liaison between Compliance Vendor and Revenue Cycle.

3. Lead training sessions on current billing and coding information in the medical field.

4. Develop curriculum and training handbook and create presentations.

5. Perform quality assurance reviews to assess comprehension of training efforts and assure coding quality.

6. Research updated coding information and communicated changes to physicians and billing staff.

7. Provide continual coding and payer updates.

8. Maintain knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures.

9. Identify elements of a medical record’s structure and content and code abstracting.

10. Works closely with physicians to ensure that charges are being accurately and compliantly being captured, coded, and billed compliantly.

11. Builds strong relationships and facilitate effective communication between hospital and physician-based Revenue Cycle.

Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.

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