Compliance Auditor Senior - Healthcare Legal and Regulatory (Eastern United States resident)

Job Summary

Job Duties

One of the following coding or auditing certifications are required (CCS, CPC, RHIA, RHIT or CPMA).

• Performs scheduled facility and/or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD 10) and billing as required by the Compliance work plan reflecting scheduled activities and target dates.
• Performs audits resulting from unplanned investigations.
• Q/A work products of peers and serve as a mentor for compliance staff.
• Serves as primary lead for facility/professional billing compliance education, including auditing, trending, providing audit feedback to facility/professional coding staff and providers working in the hospital and office setting.
• Coordinates the development and implementation of corrective action and improvement plans with critical attention to performing a root cause analysis.
• Prepares responses to governmental audits, evaluate findings, and manage the appeals process.
• Assess compliance risk areas across Geisinger entities and assist with creating the Compliance Department’s work plan.
• Performs research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
• Provides compliance guidance to Geisinger staff and serve as an institutional resource for Geisinger leadership, management and medical staff with a focus on federal payor billing compliance.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

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Position Details

Education

Experience

Certification(s) and License(s)