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   Current UPMC employees must apply in HR Direct

Compliance Auditor, Senior I

  • Job ID: 210002UJ
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Finance
  • Department: Corporate Compliance
  • Location: 3600 Forbes Ave, Pittsburgh PA 15213
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

Do you have a strong coding background and are looking for the next step in your career?  Look no further!  UPMC Corporate Services is hiring a Compliance Auditor, Senior I.

As the Compliance Auditor, Senior I,  you will provide technical expertise to review staff to ensure that all physicians, clinical, billing and coding staff are adhering to all guidelines for compliance as set forth by governmental, regulatory agencies and third party payors. Provides quality assurance for internal audit processes; oversight to ensure review process is on target and ensures effective communication of regulation updates. This position is predominately located onsite and could have workplace flexibility after training. 

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:

  • Performs in accordance with system-wide competencies/behaviors.
  • Performs other duties as assigned.
  • Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations.
  • Communicate to key stakeholders regarding audit findings and corrective actions.
  • Conduct UPMC wide auditing and monitoring to ensure coding/documentation combinations and medical record documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards.
  • Conduct audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy
  • 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.
  • Develop concise and well referenced audit workpapers.
  • Maintain current knowledge and understanding of regulatory trends and changes in coding policy and reimbursement methods. 
  • Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.
  • Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCS DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.

 

Qualifications

  • High School Diploma or equivalent required.
  • Associates Degree or higher or comparable technical school diploma is required.
  • 4 or more years of experience in medical coding, billing, auditing and compliance.
  • Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG, or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
  • Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. Experience in an academic medical center setting is strongly preferred.
  • Knowledge of key revenue cycle processes, and clinical documentation is strongly preferred.
  • Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is required.
  • Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily. Must have strong interpersonal, organizational, analytical and communication skills.
  • Ability to work in a fast-paced environment.
  • Must have ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department and with other departments.
  • Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential.
  • Experience researching and interpreting regulation and performing internal investigations is essential.
  • Attention to detail is critical to the success of this position.
  • Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
  • Data Analytics experience is strongly preferred.


Licensure, Certifications, and Clearances:

  • Certified Coding Specialist (CCS)
  • Certified Inpatient Coder (CIC)
  • Certified Evaluation & Management Coder (CEMC)
  • Certified Professional Medical Auditor (CPMA)
  • Certified Professional Coder (CPC)
  • Certified Medical Coder (CMC)

OR

  • Registered Health Information Administrator (RHIA)
  • Registered Health Information Technician (RHIT)

OR

  • Licensed Professional Nurse (LPN)
  • Registered Nurse (RN)

 

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct