The Johns Hopkins University
Compliance Auditor
The Johns Hopkins University, Baltimore, Maryland, United States, 21276
We are seeking a
Compliance Auditor
who will provide audit and research support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditor/Trainers, Leads, Manager and Director to provide input and assist in the development of any applicable training and education content. Assists in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program.Specific Duties & ResponsibilitiesConducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.Verifies and corrects as necessary, the audit work completed by the Auditors.Reviews documentation or coding patterns by a provider, division or department that poses a compliance risk and provides input on recommended solutions.Assist with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.Participate in provider feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation reviews and provides input and support as needed.Supports the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs.Assists in the research and development of medical record documentation standards and requirements related to clinical services billing.Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.Performs other compliance related activities as necessary.Minimum QualificationsBachelor’s Degree in health care-related or business-related field.Minimum of two years of auditing/billing compliance required.A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required.Preferred QualificationsFive years of experience preferred.Additional coding certifications preferred.Special Knowledge, Skills & AbilitiesRequires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.Must be able to learn quickly and work independently to address a variety of complex issues.Must be flexible to adjust to the development and refinement of new processes and procedures.CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.Demonstrated communication, analytical and organizational skills are essential.Demonstrated training or teaching experience preferred but not required.Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems preferred.Must be self-motivated and comfortable working independently, as a team member.Physical RequirementsSitting in a normal seated position for extended periods of time.Reaching by extending hand(s) or arm(s) in any direction.Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.Communication skills, using the spoken word.Ability to see within normal parameters, ability to hear within normal range and ability to move about.*This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
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Compliance Auditor
who will provide audit and research support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditor/Trainers, Leads, Manager and Director to provide input and assist in the development of any applicable training and education content. Assists in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program.Specific Duties & ResponsibilitiesConducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.Verifies and corrects as necessary, the audit work completed by the Auditors.Reviews documentation or coding patterns by a provider, division or department that poses a compliance risk and provides input on recommended solutions.Assist with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.Participate in provider feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation reviews and provides input and support as needed.Supports the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs.Assists in the research and development of medical record documentation standards and requirements related to clinical services billing.Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.Performs other compliance related activities as necessary.Minimum QualificationsBachelor’s Degree in health care-related or business-related field.Minimum of two years of auditing/billing compliance required.A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required.Preferred QualificationsFive years of experience preferred.Additional coding certifications preferred.Special Knowledge, Skills & AbilitiesRequires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.Must be able to learn quickly and work independently to address a variety of complex issues.Must be flexible to adjust to the development and refinement of new processes and procedures.CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.Demonstrated communication, analytical and organizational skills are essential.Demonstrated training or teaching experience preferred but not required.Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems preferred.Must be self-motivated and comfortable working independently, as a team member.Physical RequirementsSitting in a normal seated position for extended periods of time.Reaching by extending hand(s) or arm(s) in any direction.Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.Communication skills, using the spoken word.Ability to see within normal parameters, ability to hear within normal range and ability to move about.*This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
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