Medical Auditor, Compliance – CCP

Are you passionate about helping kids be their best selves?

UPMC Children’s Community Pediatrics is hiring a Full-Time Medical Auditor, Compliance to support the office Remotely.

Must live in the state of PA.

Purpose:
Under the direction of the Manager of Compliance, the Medical Auditor is primarily responsible for planning and conducting medical functions and financial chart audits, presenting audit results to employed practices, creating or overseeing the creation of appropriate audit spreadsheets, providing educational presentations to employed physician practices, completing special coding, projects, and providing coding/documentation/compliance support to employed and staff.

Responsibilities:

• Responsible for conducting special projects, which may include audits, as necessary. Special projects may require spreadsheet development as well as reports that summarize outcome of special projects.
• Perform internal retrospective, concurrent or prospective medical chart audits to assure that CPT codes billed are appropriate and supported by documentation in the patient record, and that all coding/documentation combinations are compliant with Federal and State regulations.
• Conduct post-audit compliance training sessions for physicians and non-physician practitioners as audit results dictate. These training sessions will include, but are not limited to, provision of education specific to the issues found on audit and will be largely based on the documentation, coding and billing rules as set forth by CMS and other relevant Federal and State regulatory agencies.
• Attend department meetings and present educational update or discuss unique audit findings and recommendations as requested by the Compliance Manager.
• Consult with physicians and physician staff, as needed, on documentation issues, and other regulatory issues as they arise.
• Develop and manage relationships with colleagues in a professional, independent manner to create an environment that affects necessary change to systems effecting the documentation, billing or coding services.
• Report status of all assignments and pertinent information to Compliance Manager.
• Complete, review, and submit summaries to Compliance Manager or appropriate department staff.
• Responsible for evaluating process and/or operational issues.