Randstad USA is currently assisting our client in the searching for a Compliance Auditor. Our client is one of the largest clinics in central Florida and offers excellent career opportunities and room for advancement.
Conduct Medical Compliance Review of Clinic providers for inpatient and outpatient claims.
Determines the level of inservice education needed for providers.
Communicates credible and concise findings in provider reports.
Demonstrates a contribution to the department???s operation and goals/targets for the year.
Maintains monthly log of activity, Completes a minimum of 10 charts/quarter for assigned providers. Prioritizes workload maintains control over interruptions.
Pursues medical records needed from outside resources (i.e. SNF, other hospitals)
Identifies departmental process discrepancies during review process. Compiles monthly documentation of keying errors by provider, DOS, MRN and batch number. Reports any operational areas of risks identified. Reports treatment inconsistencies for review.
Adheres to guidelines set by the clinic???s Compliance Program and Audit policy and procedures
Reports clear and detailed recommendations to improve documentation of level of service billed specificity of ICD10 codes and RAF scores.
Conducts chart reviews of medical records for outpatient/inpatient providers. Reports on documentation to support CPT, ICD10, HCPCS and RAF reviews.
Identifies deficiencies and educational needs of provider.
Working hours: 8:00 AM - 5:00 PM
Provides timely provider communication by memo and telephone.
Presents in a professional, organized and positive manner.
Demonstrates ability to use auditing software program, IDX system, LCD and local hospital resources to conduct reviews and summary of findings.
Ability to use the TES program in IDX for retrospective or concurrent reviews.
Required Education and Experience:
High School diploma or equivalent and a minimum of 5 years coding/healthcare reimbursement experience.
Certification by American Academy of Professional Coders (CPC) for a minimum of 5 years or equivalent organization and CRC (Certified Risk Coder).
CRC certification must be obtained within 6 months.
Must have advanced knowledge in medical terminology and anatomy. Must have advanced knowledge of insurance reimbursement, principles and practice. Must have knowledge of computer and Microsoft Office.
This position is a direct hire opportunity, and we can get you in front of the hiring manager as soon as today! Ask me how. Well, I will tell you. It is simple. Click on the EASY APPLY button to submit your application and resume. We can set up a digital interview for you to complete at your convenience.
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