Physician Auditor - Compliance
Establishes effective working relationships and builds credibility within the Steward entities to support a culture of compliance.
- Identifies potential risk areas and assists the Steward entities with developing risk mitigation and/or corrective action plan strategies.
- Under the direction of the Executive Director, Compliance & Privacy Operations, acts as a consultative resource on issues concerning billing compliance, and provides recommendations to enhance policies, procedures and internal controls as needed.
- Plans and performs compliance audits of individual physicians, mid-level practitioners and nurses on documentation, coding and billing requirements and related education activities as assigned.
- Assists in performing other compliance audits as requested.
- Produces well-written, accurate draft audit reports for review by the Director, Revenue Integrity Audits on a timely basis.
- Assists with quality assurance peer review of other team members audit work as assigned.
- Provides recommendations to improve documentation, coding or billing practices, correct any discrepancies discovered during audits, and prevent reoccurrence.
- Assists with the development and delivery of compliance training programs as assigned.
- Logs identified issues in the OCCP database accurately and timely.
- Works collaboratively with appropriate Steward workforce members to resolve compliance issues as assigned.
- Monitors the implementation status of management's corrective action plans in response to identified compliance issues as assigned.
- Assists with investigations of compliance concerns at the assigned Steward entities that are raised through the Compliance Support Line or other communication mechanisms.
- Bachelor's degree required or at least 5 years of coding/auditing experience.
- Minimum of 5 years' experience in a health care.
- Prior experience as a compliance auditor and education instructor preferred.
- Certified Coding Specialist--Physician-Based (CCS-P) or Certified Professional Coder (CPC) required.
- Additional specialty coding certifications (e.g., Evaluation and Management, Emergency Department, etc.) desired.
- Microsoft Outlook, Word, Excel, Internet Explorer and PowerPoint Skills Required.
- Microsoft Access Skills preferred.
- Ability to effectively navigate electronic health records and physician billing systems is required.
- Ability to research applicable Medicare, Medicaid and other compliance requirements is required.
- Must have a valid driver's license, provide own transportation, and be able to travel to Steward locations
Job Status: Full Time
Job Reference #: I49534