Emory Healthcare is seeking a Professional Coding Compliance Auditor dedicated to ensuring the integrity of our professional billing and coding practices. In this role, you will report to the Manager, Compliance Audit and Analysis and be instrumental in developing and executing our compliance audit, monitoring, and education programs.
What You'll Do
- Prepare and oversee the professional billing and coding components of the Compliance work plan.
- Lead focused audits and reviews to assess adherence with professional billing compliance policies and legal requirements.
- Assist in developing organizational compliance auditing and monitoring activities for professional billing and coding.
- Coordinate sample reviews to ensure billed codes are properly supported by provider documentation.
- Create audit result reports for review with providers.
- Organize and schedule audit findings and education sessions with providers.
- Conduct sample and focused reviews to ensure provider coding and billing is compliant with government and payor guidelines.
- Analyze and review medical record documentation and billing data for all pertinent audits.
- Collaborate with clinical and administrative staff and leadership to disseminate and explain audit results.
- Manage investigations and audit findings in MDAudit and escalate findings to the Manager as needed.
- Support professional billing compliance education through auditing, trending, and feedback for providers and coders.
- Assist with developing and delivering educational and training programs for professional billing and clinical compliance.
- Collaborate with other staff on focused professional billing compliance audits and special projects.
- Maintain required credentials and participate in continuing education to stay current with best practices.
- Actively participate in departmental meetings and activities.
- Maintain confidentiality of patient, member, and staff information.
- Perform assigned work safely and report unsafe activities.
What We're Looking For
- Current Professional Coders (CPC) or other relevant industry-recognized certification.
- A minimum of three (3) years of experience with audit activities.
- Knowledge of legal, regulatory, and policy compliance issues related to coding, billing, procedures, and documentation.
- Ability to clearly communicate coding information and audit results.
- Proficiency in root cause analysis, critical thinking, and gaining acceptance of recommended solutions.
- Strong interpersonal, communication, writing, and presentation skills.
- Strong orientation to deadline and detail, with excellent organizational and project management skills.
- Working knowledge of Microsoft Word, Access, Excel, PowerPoint; as well as EMR.
- Knowledge of healthcare financial management principles and practices.
- Ability to work in highly matrixed environments and adapt to change.
- Proficiency in MDAudit Enterprise software and Epic electronic health record systems.
- Thorough knowledge of coding documentation improvement practices.
- Thorough knowledge of billing, coding, and documentation requirements, Federal and State regulations, unbundling edits, medical necessity, and professional billing requirements.
Nice to Have
- A Bachelor's degree.
- Certification in Healthcare Compliance.
- Project management experience.
Technical Stack
- MDAudit Enterprise software
- Epic electronic health record systems
- Microsoft Word
- Microsoft Access
- Microsoft Excel
- Microsoft PowerPoint
- EMR
Team & Environment
You will report directly to the Manager, Compliance Audit and Analysis.
Work Mode
This role is onsite.
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
