Compliance Hospital Auditor
Tampa, Florida

Job ID: 11249
Start Date: ASAP
Type: Temp-to-Hire
Job Industry: Information Technology / Telecommunications

Estimated Duration: 6 months with a possibility of direct employment with the Client.

Onsite: On location at the Client’s site 100% of the time. No telecommuting or remote work.

Description: Our Client, a non-profit medical research center, is hiring a Compliance Hospital Auditor in Tampa, FL.

Responsibilities:

• Plan and perform scheduled and unscheduled compliance department audits of facility and technical fee documentation, coding and medical necessity related to inpatient and outpatient billing;
• Adhere to defined audit timeline and audit protocol standards; assist with development of the audit schedule; identify services to be audited;
• Apply consistent and standardized compliance audit methodology for sample selection, scoring and benchmarking, development andreporting of findings and repayment calculations;
• Evaluate the appropriateness of services and procedures billed based on supporting documentation;evaluate appropriateness of ICD, HCPCS and CPT codes billed;evaluate the appropriateness of APC, DRG and admission assignments; evaluate appropriateness of modifier usage; make determinations of overpayments and underpayments and performs other related analysis and evaluations;
• Prepare written reports of audit findings and recommendations and presents to appropriatestakeholders; evaluate the adequacy of management corrective action to improve deficiencies; maintain audit records;
• Conduct risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices;
• Develop compliance training content; provide one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others to ensure compliance with federal and state regulations and laws, CMS and other third party payor billing rules and internal documentation, coding and billing policies and procedures;conduct compliance orientation training to new providers one-on-one or in a group session;
• Research, abstract and communicate federal, state and payor documentation, billing and coding rules and regulations; stay current with Medicare, Medicaid and other third party rules and regulations, DRG, APC, CPT and ICD coding updates, Coding Clinic Guidelines; serve as institutional subject matter expert and authoritative resource in these areas.

Requirements:

• AAPC or AHIMA coding certification (CPC, CPC-H, CHA, RHIA, or CCS) (required);
• Knowledge of evaluation and management coding and auditing (required);
• Knowledge of Medicare and Medicaid documentation and coding rules and guidelines or medical necessity defense reviews;
• Knowledge of ICD/CPT/HCPCS/DRG/APC documentation coding rules;
• Knowledge of facility fee charge capture and reimbursement methodologies;
• Knowledge of MS-DRG application, CMS manuals; medical necessity guidelines;
• Experience working with enterprise databases and analytics;
• Hospital fee auditing experience in an Academic Medical Center (preferred);
• Auditing certification of CPMA (preferred);
• Knowledge of Soarian and/or Cerner Powerchart applications (preferred);
• Certification in Healthcare Compliance (CHC) by the Health Care Compliance Association (preferred);
• Bachelor's degree and a minimum of 3 three years of experience in facility fee coding / auditing, medical necessity reviews or related work or diploma and a minimum of seven 7 years experience.

If this job is not for you, earn a $2,100.00 referral bonus in cash by referring a Candidate or a Client to us. Vitaver Referral Program is one of the most generous on the market!

Please feel free to apply directly and contact me with your questions at iris.kobs@vitaver.com

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Vitaver & Associates, Inc. is an equal opportunity employer. It is the Company's policy to make all employment decisions including hiring, promotion, compensation, benefits, termination and others, without regard to age, race, color, religion, national origin, sex, disability, veteran status, or any other protected status in accordance with applicant federal, state, and local laws.
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