Compliance Auditor

Medical Billing Auditor

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Salary Range: $68,000.00 - $120,500.00

Coordinate and conduct medical billing audits for the Yale Medicine Administration. Evaluate medical billing, coding and documentation for 18 clinical departments under the direction of the Compliance Officer. Provide training and feedback to physicians and departmental personnel who have responsibilities with billing activities. This opportunity is currently remote (work from home, in or outside CT) for a position located in CT.

CPC or similar certification needed within 12-18 months.

Required Skills and Abilities

1. Demonstrated knowledge of ICD-10 and CPT-4 coding and billing practices.

2. Ability to interpret operative and procedural reports.

3. Well-developed oral and written communication skills.

4. Strong attention to detail with the ability to analyze data.

5. Proficient in Microsoft Word, Excel, and Access.

Principal Responsibilities

1. Primary responsibility is to complete audits of departmental compliance chart reviews and to participate in audits requested by third party payors.

2. Assess provider documentation for IDC-10 and CPT-4 coding accuracy, compliance with University and government regulations.

3. Obtain and review charge documents, encounter forms, medical records and billing procedures.

4. Evaluate results, identify system control weaknesses and in conjunction with department management, develop plan of action and solutions based on audit results.

5. Participate in the implementation of corrective action changes.

6. Design and maintain accurate tracking logs, including spreadsheets, of all ongoing investigations.

7. Follow up on corrective action. Report findings to the Compliance Officer, PFS and University Auditor as needed.

8. Conduct training sessions with individual physicians and/or departments on medical billing compliance. Provide input on areas and subjects where education is needed.

9. Advise and assist in development of training materials and programs for clinical and billing staff relative to accurate coding, documentation billing and regulatory guidelines.

10. Conduct data analysis. Generate reports using Query tools to identify trends and problem areas for focus of internal audits.

11. Participate in the ongoing implementation of the Compliance Program. Knowledge of University Medical Billing Compliance Plan, operations and procedures.

12. Stay abreast of best practice coding and auditing practices and regulatory changes. Maintain CPC designation by obtaining necessary CEUs on an annual basis.

Required Education and Experience

Bachelor's in Health Care Management, Finance, Business or Nursing or a related field. Five years' experience in multi-specialty group practice, academic plan or hospital or an equivalent combination of educational and experience.