POSITION SUMMARY:
Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records.
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES:
- Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions.
- Conducts ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas.
- Maintains tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data.
- Participates in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives.
- Provide reports to management on compliance metrics and audit findings as requested.
Requirements
EDUCATION AND QUALIFICATIONS:
- RN or LPN required
- A minimum of three to five years experience in Medicare, Medicare Advantage, and/or Commercial Payers preferred.
- Strong knowledge of Florida statues, Medicare & Medicaid conditions of participation and payment, and commercial payer guidelines preferred.
SKILLS AND COMPETENCIES:
- Ability to accurately interpret regulations, payment and coding guidelines.
- Ability to manage multiple priorities simultaneously and effectively handle the emotional stress of the workload.
- Ability to work independently exercising confidentiality, discretion and independent judgment.
- Ability to work in collaboration with other disciplines within the organization.
