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

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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