Compliance Auditor

New York, New York 10036The Compliance Auditor performs medical coding audits for providers in accordance with the departmental workflow. The medical record or progress note will be audited for documentation to ensure compliance with CMS guidelines and applicable payor guidelines. The Compliance Auditor Interacts with employees within the Compliance Department.

Company Description

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

Role Title: Compliance Auditor

FLSA Category: Exempt

Role Location: Remote

Reporting Relationships:

This position reports to Director of Medical Coding & Compliance Auditing.

Role Summary and Responsibilities:

The Compliance Auditor performs medical coding audits for providers in accordance with the departmental workflow. The medical record or progress note will be audited for documentation to ensure compliance with CMS guidelines and applicable payor guidelines. The Compliance Auditor Interacts with employees within the Compliance Department.

Key Responsibilities / Essential Functions:

• Review documentation to ensure appropriate assignment of ICD-10 codes, CPT codes and modifiers for facility based and provider based clinical documentation.
• More than 80% of the role will be spent auditing.
• Audits medical record documentation to identify under coded and up coded services; prepares reports of findings.
• Researches, analyzes, and responds to inquiries from Legal Team and others regarding compliance, inappropriate coding, denials, and billable services.
• Generates reports as needed through various systems.
• Knowledge of payers in NJ, NY, PA, and FL.
• Performs miscellaneous job-related duties as assigned.

Non-Essential Functions:

• Other duties, as assigned.

Qualifications:

• Associate or Bachelor's degree.
• Equivalent of 3+ years' experience in medical coding, reimbursement and regulatory compliance audits.
• Coding Certification of at least one of the following are required from AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders):
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Proficient in Microsoft Office Suite software and Windows 10
• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems.
• Strong communication and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Ability to clearly communicate medical information to professional practitioners and/or the public.
• Detailed knowledge of medical coding systems, procedures, and documentation requirements.
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
• Ability to provide guidance and training to professional and technical staff in area of expertise.

Physical Requirements:

• Mainly sedentary.
• Sitting at the desk most of the day.
• Standing or walking less than two hours per day.
• Lifting no more than ten pounds on rare occasions.
• Must be able to work at a computer and answer phone calls on a regular basis.

Featured Benefits:

• Health, dental, and vision insurance.
• 401K with automatic employer contribution.
• PTO and Paid Holidays.
• Company paid Life Insurance.
• Access to voluntary short and long-term disability insurance.
• Access to additional life insurance.
• Access to a variety of Wellness programs.

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as "protected characteristics").

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.

The Salary range for this position is

$53K/yr - $74K/yr

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.