Compliance Billing & Coding Auditor II (Remote)

About this role

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered. 

Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview Billing and Coding Compliance Auditors conduct audits and monitoring activities to identify and address compliance risks related to billing and coding practices. They review and evaluate healthcare regulatory compliance, focusing on the detection of documentation, coding, and billing errors. Responsibilities include assessing the adequacy and accuracy of documentation supporting billed services, including ICD, CPT, HCPCS, and other third-party payer codes, as well as adherence to Teaching Physician guidelines, Evaluation & Management criteria, DRG and APC assignments, medical necessity, and reimbursement accuracy.

Auditors serve as a communication channel, partnering with Billing and Coding Compliance Educators to address compliance issues. They are responsible for conducting thorough investigations into billing and coding compliance matters, ensuring adherence to regulatory standards, and identifying discrepancies. This role involves analyzing data, collaborating with relevant departments, and implementing corrective actions to enhance compliance and mitigate risks.

Career Banded Levels: Billing and Coding Compliance Auditor Family There are three (3) career banded levels within the Billing and Coding Compliance Auditor family, with positions flexibly staffed at any of these levels. Progression to a higher level is contingent upon the need for the position, the nature, scope, and complexity of assigned duties, and the employee's demonstrated knowledge, skills, abilities, and professional behaviors.

Billing and Coding Compliance Auditor II is the full proficiency or journey level of the Billing and Coding Compliance Auditor Family where employees are responsible for independently performing the full range of duties of moderate difficulty and complexity as outlined under the Job Duties. Performs audits of limited scope with greater independence. May be responsible for determining audit scope, procedures, and key controls.

Locations Stanford Health Care

What you will do • Initiate and perform proactive coding and billing audits to identify potential coding and billing errors before claims submission, ensuring compliance with coding guidelines and reducing the risk of denials or audits by payers. May also conduct retrospective audits when required.

• Leverage auditing software and tools to streamline the auditing process, enhance data analysis capabilities, and improve the overall efficiency of billing and coding audits.

• Monitor and analyze billing and coding data to detect patterns of errors or non-compliance with regulatory standards and evaluate medical services for accuracy in the assignment of ICD, HCPCS, CPT codes, E&M, APC, DRG assignments, and charges.

• Review documentation supporting billed services to ensure accuracy and compliance and assist in identifying compliance risks through risk assessments based on previous audit findings and industry best practices.

• Conduct comprehensive investigations into billing and coding compliance issues to identify discrepancies and potential violations, including independent audits of facility and professional fee accounts for all patient types.

• Collaborate with relevant departments to gather information, evaluate documentation, and perform investigations related to potential compliance issues.

• Prepare detailed audit and investigative reports summarizing findings, recommendations for corrective actions, and areas for improvement, while monitoring the implementation of these actions to assess their effectiveness.

• Provide feedback to Billing and Coding educators to inform the development of training materials and enhance future educational content.

• Stay updated on federal, state, and payer regulations, as well as changes in healthcare regulations and coding guidelines, to ensure ongoing compliance.

• Participate in compliance training sessions and workshops to enhance knowledge and skills related to billing and coding practices and assist in developing compliance training content for various revenue cycle departments.

• Assist Billing and Coding educators in responding to inquiries regarding compliance matters.

• Contribute to the overall development and realization of the Office of Compliance and Privacy’s Risk Assessment, Workplan, and strategic goals.

Education Qualifications • Associate’s degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience) required.

Experience Qualifications • Minimum four (4) years of progressively responsible directly related work experience required.

• EPIC EHR experience preferred.

Required Knowledge, Skills and Abilities • Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.

• Ability to communicate effective in written and verbal formats including summarizing data and presenting results.

• Ability to provide leadership in problem identification and issue resolution.

• Ability to change the course of events through convincing arguments supported by data.

• Ability to apply Critical Thinking skills to issues and situations.

• Ability to mediate and solve complex work problems and issues.

• Ability to effectively facilitate work groups to successful outcomes.

• Knowledge of coding conventions including ICD-10-CM/PCS, HCPCS, E&M, and CPT.

• Knowledge of DRG/APC reimbursement.

• Knowledge of third party payer rules and regulations.

• Knowledge of healthcare compliance audit requirements, principles and techniques.

• Ability to plan, organize and conduct detailed healthcare corporate compliance functions and audits to identify and eliminate waste, fraud and abuse, and inefficiencies in conform

Similar jobs

• Outpatient Coding Consultant - Remote — Datavant2 · Remote
• Professional Billing- Coding/Education Specialist - REMOTE — UMass Memorial Health · Remote
• Patient Account Representative II (Remote) — Stanford Health Care · Remote
• Profee Surgical Coding Specialist III - REMOTE — Camping World · Remote
• Audit and Coding Consultant — HonorHealth · Deer Valley - 2500 W Utopia Rd Phoenix, AZ
• Insurance Billing/Collection Assistant II (Hybrid) - Physicians Billing Service — Washington University in St. Louis · St. Louis, MO
• Clinical Quality Assurance Specialist - Remote (Part-time) — Bravehealth · Remote
• Coding Auditor (Hybrid), Day Shift, Revenue Integrity — Adventist HealthCare · Rockville, MD