收入周期合规审计师
Revenue Cycle Compliance Auditor
位于萨克拉门托都会区，安息日会健康公司总部自40多年前以来一直设在加利福尼亚州罗斯维尔。2019年，我们推出了经过WELL认证的园区——一个让全系统员工协作、创新和连接的焕新场所。
安息日会健康罗斯维尔及共享服务团队可以享受一个旨在促进健康并激发最佳工作的欢迎空间。
职位概述：
独立执行与医疗相关活动的项目、合规性和风险审查，以确保相关医疗记录文档、编码、计费和政策的准确性。撰写书面审计摘要，包括审计建议。进行收入周期调查，通过发现、报告和行动计划确定并减轻风险。负责根据审计结果协调、开发和开展教育培训。为编码员、计费员、医生和其他人员提供关于文档要求和住院、门诊及专业费用服务正确编码的教育培训。协助公司合规部门维护医院的公司合规计划。
职位要求：
教育和工作经验：
- 专科/技术学位或同等教育/相关经验组合：必需
- 本科学位：优先考虑
- 五年医疗编码经验，包括住院、门诊、农村医疗和/或专业费用服务：必需
- 三年诊所和/或设施收入周期审计经验：优先考虑
执照/认证：
- 注册编码专家（CCS）或注册专业编码员（CPC）或注册编码专家-医生（CCS-Phy）：必需
- 注册专业医疗审计师（CPMA）或注册E&M审计师（CEMA）或注册健康信息技术人员（RHIT）或注册健康信息管理员（RHIA）或医疗合规认证（CPC）或注册E/M编码员（CEMC）或注册文档改进从业者（CDIP）或注册临床文档专家（CCDS）：优先考虑
- CCS 或 CCS-Phy 或 CPC：必需
主要职责：
- 对医疗记录进行全面审查，确保收入周期计费合规性，包括但不限于：医疗必要性、合规风险、拒付审查、费用趋势以及应用的CPT、HCPCS、ICD 10-CM等。
查看英文原文
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Works independently performing program, compliance and risk-based reviews of health care related activities to ensure accuracy of related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended actions through an action plan. Responsible for coordinating, developing and conducting educational training based on audit outcomes. Provides educational training to coders, billers, physicians, and others on documentation requirements and correct coding of inpatient, outpatient and professional fee services. Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program.
Job Requirements:
Education and Work Experience:
- Associate's/Technical Degree or equivalent combination of education/related experience: Required
- Bachelor's Degree: Preferred
- Five years' experience in healthcare coding inpatient, outpatient, rural health care and/or professional fee services: Required
- Three years' experience in auditing in clinic and/or facility revenue cycle: Preferred
Licenses/Certifications:
- Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist – Physician (CCS-Phy): Required
- Certified Professional Medical Auditor (CPMA) or Certified E&M Auditor (CEMA) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified in Healthcare Compliance (CPC) or Certified E/M Coder (CEMC) or Certified Documentation Improvement Practitioner (CDIP) or Certified Clinical Documentation Specialist – (CCDS): Preferred
- CCS OR CCS-Phy OR CPC: Required
Essential Functions:
- Performs comprehensive reviews of health care records for accuracy of revenue cycle billing compliance to include but not limited to: medical necessity, compliance risk, review of denials, charge trends, and applied CPT, HCPCS, ICD 10-CM and ICD-10-PCS coding guidelines for inpatient, outpatient, and/or clinic visit encounters that correlates to clinical documentation.
- Produces comprehensive audit finding reports that include quantifiable impact, identify areas of opportunity for education, as well as improvement recommendations. Generates audits utilizing Auditing platform for denials, coding reviews and other risk-based data for department audits as appropriate.
- Communicates clearly (verbally and in written reports or summaries) opportunities regarding proper clinical documentation guidelines, service selection, charge capture and timely submission, healthcare data accuracy and coding principles.
- Participates in improving the efficient and effective delivery of the Department's services including promoting the department brand, complying with department and professional standards, participating in department initiatives and internal process improvement projects, and providing input into the enhancement of audit methodologies, workflows and tools. Participates in annual risk assessment and work plan development processes.
- Works collaboratively in a team environment to support the hospital, surgical and clinical practices as well as AH leadership on revenue cycle compliance.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
Originally posted on Himalayas