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Compliance Auditor - SRS

Sharp Healthplan

San Diego, CA

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JOB DETAILS
SALARY
$34.17–$44.09 Per Year
SKILLS
Administrative Skills, Ambulatory Care, Analysis Skills, Apple Macs, Auditing, Billing, Centers for Medicare and Medicaid Services (CMS), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Clinical Practices/Protocols, Coding Standards, Communication Skills, Conferences, Corporate Compliance, Current Procedural Terminology (CPT), Data Collection, Documentation, Documentation Review, Documentation Standards, Health Information Management, Healthcare, Healthcare Common Procedure Coding System (HCPCS), ICD-10, Identify Issues, Insurance Documentation, Interpersonal Skills, Maintain Compliance, Medical Coding, Medical Records, Medical Treatment, Medicare, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Organizational Skills, Outpatient Care, Patient Care, Presentation/Verbal Skills, Privacy Regulations, Problem Solving Skills, Professional Services, Publications, Regulatory Compliance, Reporting Skills, Risk Analysis, Schedule Development, Third-Party Payer, Time Management, Trend Analysis, Writing Skills
LOCATION
San Diego, CA
POSTED
Today
Hours:Shift Start Time:VariableShift End Time:VariableAWS Hours Requirement:8/40 - 8 Hour ShiftAdditional Shift Information:Flex hours are 6:00-9:00 am to 14:30-17:30 pmWeekend Requirements:As NeededOn-Call Required:NoHourly Pay Range (Minimum - Midpoint - Maximum):$34.170 - $44.090 - $49.370The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.What You Will DoTo identify and report coding and documentation practices and make recommendations which assure the accurate reporting and documentation of services provided by entity clinical providers. To support and facilitate the implementation of correct coding standards by clinical providers as established by SHC Corporate Compliance in accordance to the CMS and local MAC (Medicare Administrative Contractor) requirements.Required Qualifications* 3 Years experience auditing coding and medical record documentation in an ambulatory care setting.* Experience developing training materials and presenting to a large group of professionals.* Certified Professional Coder (CPC) - AAPC OR Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA) -REQUIREDOther Qualification Requirements* Two years of college or five years working experience in a healthcare environment related to auditing of medical records and CMS compliance. - RequiredEssential Functions* AuditingParticipates in audit risk assessment for each division/provider to determine trends and helps management identify need for more frequent audits.Is able to analyze and create concise reports quantifying and summarizing audit findings. Presents the findings to Departments, Divisions, and at the Individual Provider level.Adheres to audit schedules and deadlines; prioritizes workload; communicates to management appropriately regarding workload and priority concerns.Utilizes internal and professional resource tools to provide quality audit results.Performs concurrent audits according to a defined audit schedule to assure that the documentation meets the standards set by CMS, local Medicare Administrative Contractor (MAC) and other third party payers.Performs provider quality audits to ensure provider is billing to meet established coding guidelines.* Client supportProvider, Clinical, and Coding SupportServes as a resource providing support to SRS management, physicians, administrative and support staff for coding, documentation and compliance.Provides support with TES/CM edit resolution at assigned sites and assists with coding related edit questions.Provides professional and courteous support to providers, clinical staff, PFS, via email, phone and in-person contact, answering questions and providing supporting documentation for compliance standards.* Communication and trainingEffectively communicates audit results to supervisor, manager and/or director as appropriate.Provide timely feedback and final resolution of identified issues.Schedules and provides 1:1 training to provider to ensure maximum coding compliance guidelines are followed.Evaluates the inpatient and outpatient training and coding areas for improvement for assigned specialties and incorporates education specific to the needs of the specialty.Develops and maintains tools, guidelines and procedures to assist in provider's understanding of requirements for medical documentation and coding.Performs training for new providers with timely feedback on their documentation.* ComplianceHas a thorough understanding of ICD-10 and CPT coding guidelines.Protects all work products, working papers, personal lap top, and other related documents and/or portable electronic data systems in accordance with SHC and regulatory privacy and confidentiality guidelines.Stays current with Medicare updates and specialty specific professional services updates; communicates changes to management.* Data collection and reportingDesigns and develops reports within a specified timeframe.Analyzes trends while reviewing documentation and communicates to management.Reports findings identified during documentation reviews and includes official references related to the findings.* EducationReviews coding publications for changes, clarifications and/or information pertinent to the medical group's specialties/services.Attends and participates in job related conferences, seminars and workshops to enhance skills and keep current on coding and documentation changes.Presents to management complete supporting documentation associated with areas of concern.Knowledge, Skills, and Abilities* Excellent working knowledge of CPT, ICD-10 and HCPCS codes is required.* Thorough understanding of Medicare, insurance documentation, and compliance and coding requirements.* Expert knowledge of MS Office which includes: Excel, Word, and PowerPoint.* Ability to educate and train all levels of clinical and professional staff.* Excellent interpersonal skills verbal and written, with the ability to communicate to all levels of staff within the organization.* Ability to produce high quality work/reports with minimal error rate.* Professional approach to work including ability to exercise mature judgement and maintain confidentiality in all activities.Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

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Sharp Healthplan