Overview
The Compliance Auditor Provider Liaison is responsible for conducting detailed audits of professional coding and provider documentation across numerous specialties, identifying compliance risks, and promoting best practices through education and feedback. The auditor partners closely with providers, coders, and revenue cycle leadership to ensure alignment with organizational policies, payer requirements, and federal regulations.
Qualifications
Education:High School diploma or GED required.
License: Certified Coder with Auditing Certification with AAPCExperience: Minimum of 5 years of experience in a hospital or professional revenue cycle. Minimum of 5 years coding experience with CPC certification. Minimum of 3 years of coding auditing experience. Broad exposure to multiple specialties such as cardiology, general and specialized surgery, oncology, and primary care/nternal medicine strongly preferred. Deomonstrated experience educating or training providers on documentation and coding standards.
Additional Skills/Abilities: Requires thorough understanding of Medicare/Medicaid guidelines as well as commercial insurance policies regarding coverage, medical necessity and billing standards. Thorough knowledge of healthcare compliance, including HIPAA. Strong organizational and problem solving skills with the ability to manage and prioritize multiple responsibilities in a fast-paced, stressful environment. Proficient in operating the software system as it relates to billing and reporting functions. Demonstrated ability to assess work flows and to develop process improvement recommendations. Excellent verbal, written and attentive listening communication skills. Strong collaborative skills to develop effective working relationships with staff, other managers, other departments and upper management. Ability to coach and mentor staff to promote optimal effectiveness teamwork and morale. Strong analytical, investigative, and problem-solving skills. Excellent communication and interpersonal skills for engaging with providers and leadership. High attention to detail, confidentiality, and integrity.