Job Description
Job Title: Medical Auditor, Compliance (Coding)
Job ID: 711431
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Corporate Compliance
Location: 5150 Centre Avenue, Pittsburgh PA 15232
Description
Purpose:Shape the world of health care by
joining UPMC! We are looking for a
Medical Auditor to join our Cancer Center Compliance team. This role, under the direction of the Manager
of Compliance, is primarily responsible for planning and conducting Evaluation
and Management (E/M) chart audits, presenting audit results to employed
practices, creating or overseeing the creation of appropriate audit
spreadsheets, and providing educational presentations to employed physician
practices. The Medical Auditor will be responsible for external payer audit
requests, financial chart audits, completing special projects, and providing
coding/documentation/compliance support to employed UPMC Hillman Cancer Center staff.
This position is located at the
Cancer Pavilion in Shadyside. The
schedule for this opportunity is Monday through Friday during daylight
hours. Are you ready to join our Cancer Center
team? Apply today!
Responsibilities:- 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.
- Complete, review, and submit
summaries to Compliance Manager or appropriate department staff.
- Consult with physicians and
physician staff, as needed, on documentation issues, and other regulatory
issues as they arise.
- Conduct post-audit compliance
training sessions for UPMC Hillman Cancer Center physicians and advanced practice
providers 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.
- 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.
- Attend department meetings and
present educational update or discuss unique audit findings and recommendations
as requested by the Compliance Manager.
- 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.
- Responsible for evaluating process
and/or operational issues throughout UPMC Hillman Cancer Center.
- Report status of all assignments
and pertinent information to Compliance Manager
Qualifications
- An associate's
degree or comparable technical school diploma is required.
- A minimum of three
years of experience in coding and documentation of physician services is
required.
- Must have
Evaluation and Management (E/M) coding knowledge.
- Advanced ICD-10 and CPT coding, anatomy and medical terminology knowledge
required.
- Must have knowledge
of the physician billing process and medical record audit process.
- Must have knowledge
of Medicare, Medicaid and local third-party carrier regulations.
- Experience in an academic
medicine environment preferred.
- Proficiency in
Microsoft Office is required.
- Must be able to
communicate effectively both orally and in writing, with people both internally
and externally.
- Must be able to
identify problems and problem areas, and bring them to an amiable
solution.
- Must possess
technical and professional skills in financial analysis as well as
interpersonal skills.
- Must possess the
ability to develop audit plans and tests to assure strong, efficient management
controls.
- Must possess
analytical problem-solving skills as well as the ability to coordinate the work
of others and communicate effectively with all levels of management.
- Must be willing to
travel within Western Pennsylvania and surrounding Regional Areas.
License/Certifications:
PREFERRED CERTIFICATIONS:
Certified Coding Specialist OR Registered
Health Information Technician OR Registered Health Information Administrator OR
Certified Professional Coder
Salary Range:
$22.60
to
$39.11
Union Position: No
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