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Medical Auditor, Compliance

  • Job ID: 968571137
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Finance
  • Department: Corporate Compliance
  • Location: 5150 Centre Avenue, Pittsburgh PA 15232
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

Are you ready to take the next step in your auditing career? Consider the Medical Auditor, Compliance at UPMC!

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 PSD staff.

UPMC has a Center for Engagement and Inclusion that is charged with executing leading-edge and next-generation diversity strategies to advance the organization’s diversity management capability and its national presence as a diversity leader. This includes having Employee Resource Groups, such as Women Inspiring Talent in Heath Care in Finance (WITH) or PRIDE Health, that support the implementation of our diversity strategy. 

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 PSD 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 throughout PSD.

 

Qualifications

  • An associate's degree or comparable technical school diploma is required or equivalent years of experience.
  • A minimum of 3 years experience in coding and documentation of physician services is required.
  • Experience in an academic medicine environment preferred. Advanced ICD-9/10 and CPT coding, anatomy and medical terminology knowledge required.
  • Proficiency in Microsoft Office.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.
  • Must be willing to travel within Western Pennsylvania.
  • The Medical Auditor 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 professionals 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.


Licensure, Certifications, and Clearances:
Cert Coding Specialist OR Reg Health Information Tech OR Reg Health Information Admin OR Cert Professional Coder Preferred


UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct