Position Overview Compliance Auditor – monitors and improves the quality of clinical and financial documentation related to the provision of patient services. Under general supervision, the Compliance Auditor compares clinical and financial records to ensure documentation supports patient charges, codifies findings, and assists in reporting, monitoring, and education.
Responsibilities Performs audits of clinical documentation of physician, technical or specialty (e.g., Home Health, Hospice, Inpatient Rehab) billing and payment records and applicable industry standard billing codes by analyzing medical records, coding records and health system bills, validating clinical documentation in conjunction with the bill; assessing the level and accuracy of coding; determining that governmental and third‑party payer regulations are being complied with; and evaluating appropriateness of billing and coding procedures.
Evaluates accuracy of coding and billing performance by individuals, coders and clinical units.
Prepares reports to assist Compliance Educators in identifying areas of risk based on the audit for education to providers.
Works collaboratively with appropriate personnel to identify and recommend strategies for process improvement related to internal auditing processes.
Coordinates responses to and analyzes risk associated with audit requests from government and commercial payers.
Interacts with co‑workers, visitors, and other staff consistent with the values of Jefferson.
Develops and conducts clinical documentation audit project plans.
Develops and maintains complex audit processes and audit tools.
Audits established guidelines for medical necessity and other specialty clinical services provided in acute care and ambulatory settings.
Identifies patterns or trends that require auditing in the data tool.
Qualifications Bachelor’s degree in Health Information Management or related field.
Certifications: CPC (Certified Procedural Coder), CCS‑P (Certified Coding Specialist – Physician), RHIA (Registered Health Information Management Administrator), RHIT (Registered Health Information Management Technician), COC (Certified Outpatient Coder), CIC (Certified Inpatient Coder). Additional certifications in specialty areas and Epic certification or experience with Epic are highly encouraged.
Minimum of three (3) years of progressive experience in coding, reimbursement and regulatory compliance audits, either through employment, consulting or other relevant capacity.
Work Information Shift: Workday Day (United States).
Location: 1101 Market, Philadelphia, Pennsylvania, United States.
Benefits Medical (incl. prescription), supplemental insurance, dental, vision, life and AD&D insurance.
Short‑term and long‑term disability, flexible spending accounts, retirement plans.
Tuition assistance and tuition discounts at Thomas Jefferson University after one year of full‑time service or two years of part‑time service.
Access to medical insurance for all colleagues, including part‑time, per‑diem, adjunct faculty and Jeff Temps.
EEO Statement Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.
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