Compliance Auditor Senior - Healthcare Legal and Regulatory (Eastern United States resident)

Senior Compliance Auditor

The Senior Compliance Auditor ensures the integrity and accuracy of facility and professional compliance audits, monitoring, and provides compliance education for facility and professional documentation, coding, and billing. The Senior Compliance Auditor serves as a mentor for Compliance Auditors and assists management with the onboarding process for new Compliance Auditors. This position requires the use of judgement and critical thinking skills to determine appropriate corrective actions for non-compliance and ensure corrective actions are fully implemented by the entity service line area.

Job Duties :

• Performs scheduled facility and / or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD 10) and billing as required by the Compliance work plan reflecting scheduled activities and target dates.
• Performs audits resulting from unplanned investigations.
• Q / A work products of peers and serve as a mentor for compliance staff.
• Serves as primary lead for facility / professional billing compliance education, including auditing, trending, providing audit feedback to facility / professional coding staff and providers working in the hospital and office setting.
• Coordinates the development and implementation of corrective action and improvement plans with critical attention to performing a root cause analysis.
• Prepares responses to governmental audits, evaluate findings, and manage the appeals process.
• Assess compliance risk areas across Geisinger entities and assist with creating the Compliance Department's work plan.
• Performs research as needed to ensure organizational compliance with all applicable coding and diagnostic guidelines.
• Provides compliance guidance to Geisinger staff and serve as an institutional resource for Geisinger leadership, management and medical staff with a focus on federal payor billing compliance.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details :

Education : Associate's Degree-Related Field of Study (Required)

Experience : Minimum of 7 years-Related work experience (Required)

Certification(s) and License(s) :

Skills : Communication, Critical Thinking, Medical Billing and Coding, Organizing, Problem Solving, Training and Education

Our Purpose & Values : Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.