Description
Are you looking to grow your career within auditing and compliance? Look no further! UPMC Corporate Services is hiring a Compliance Auditor, Associate.
As the Compliance Auditor, Associate, you will 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.
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:
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Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCD and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.
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Conduct post-audit compliance training sessions for physicians and non-physician practitioners as audit results dictate.
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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.
Qualifications
- High School Diploma or equivalent required.
- Associates Degree or comparable technical school diploma is preferred.
- 1 year of experience in medical coding, auditing, billing and compliance.
- Knowledge of CMS and third-party payer coding, billing, and documentation compliance regulations preferred (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 preferred.
- Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.
- 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.
- Ability to manage multiple tasks and projects.
- Ability to forge strong interpersonal relationships within the department and with other departments.
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)ORRegistered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)ORLicensed Professional Nurse (LPN)Registered Nurse (RN) (Preferred)
UPMC is an Equal Opportunity Employer/Disability/Veteran
Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.
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.
