顾问 - 医疗保健合规审计师 - HTS
Consultant - Healthcare Compliance Auditor - HTS
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医疗合规审计师职位是医疗交易与战略（HTS）部门的咨询岗位。HTS目前正在招聘一名顾问级别的医疗合规审计师。
HTS为医疗提供者、医疗支付方和医疗投资者提供监管、报销、数据分析和合规审计服务。合规审计的交付成果包括对提供者合规计划的评估，以及对临床文件和索赔文件的计费和编码审计。该职位需要一位积极主动的问题解决者，具备强大的分析能力、扎实的组织技能，并有在组织内晋升的意愿。医疗合规审计师的工作将涉及执行项目工作流程，主要涉及运用认证的编码技能来审计提供者的索赔和临床文档，特别关注如医疗保险和医疗补助等政府项目。职责包括与团队合作制定审计规范、对医疗索赔和支持文档进行专家分析、质量控制以及客户交付成果的开发。
顾问的工作涉及执行可能具有定性或定量性质的项目工作流程，职责包括：计费和编码审计、合规计划审查、质量控制、客户交付成果的开发以及行业研究。
该职位需要具备医学编码和合规方面的知识，潜在候选人必须具备医学审计的专业知识。职位名称和薪酬将根据资格和经验确定。
工作职责：
- 计划并执行医疗记录审计，以确定编码准确性和合规的索赔提交。
- 利用对编码和文档合规关键风险领域的了解，开发编码和文档审计方法。
- 执行编码和文档审计，审查医疗记录和费用，确保符合CPT-4/HCPCS和ICD-10-CM编码指南和标准，以及医疗保险和医疗补助服务中心（CMS）的覆盖指南。
- 分析审计结果，识别编码和文档中的趋势/问题，并有效沟通审计结果和改进建议。
- 作为编码和文档解释与应用的专家。
查看英文原文
We Do Consulting Differently
The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at the Consultant level.
HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include working with team to develop audit specifications, expert analysis of healthcare claims and supporting documentation, quality control, and development of client deliverables.
The work of a Consultant involves execution of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: billing and coding audits, compliance program review, quality control, development of client deliverables, and industry research.
This specific position will require knowledge of medical coding and compliance, and potential candidates must have medical auditing expertise. Job title and compensation to be determined based on qualifications and experience.
Job Responsibilities:
- Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
- Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance
- Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines
- Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement
- Serve as a subject matter expert on interpretation and application of coding and documentation guidelines
- Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas
- Stay current on coding guidelines.
- Develop analyses using transactional data and/or financial data
- Generate client deliverables and make valuable contributions to expert reports
- Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions
- Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting
- Prioritize assignments and responsibilities to meet goals and deadlines.
Qualifications:
- 4-year degree (BS or BA)
- Active coding certification from either AAPC (CPC, CPMA) or AHIMA (CCC-P, AOC) is required; Do not desire risk adjustment certifications (CRC, RAC) or experience. Do not desire inpatient hospital certifications (CIC, CCS) or experience.
- Preference will be given to candidates that are certified in medical auditing.
- 2+ years of work experience with a focus on healthcare provider billing and coding; Less than 10 years preferred.
- Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs).
- Preference will be given to candidates that have previously worked in a consulting firm environment in which their duties included auditing providers or providing audits associated with transactional diligence.
- Preference will be given to candidates who have worked in a role at a health plan auditing and reviewing providers in that plan’s network.
- Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation.
- Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements.
Required skills include:
- Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results.
- Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word. A desire to expand those capabilities is required, as is the ability to train others to use such tools.
- Commitment to producing high quality analysis and attention to detail.
- Excellent time management, organizational skills, and ability to prioritize work and meet deadlines.
- Keen interest in healthcare compliance and healthcare policy.
- Exceptional verbal and written communication skills.
- Desire to work within a team environment.
- Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship.
Consultant Salary Range: $70,000 – $150,000
Candidate must be able to submit verification of legal right to work in the U.S., without company sponsorship.
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Originally posted on Himalayas