Compliance/Coding Auditor Educator
Louisville, KY 
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Posted 1 day ago
Job Description
Baptist Health strives to cultivate a close-knit, positive and professional environment that encourages our employees to want to come to work every day.

When you choose Baptist, you have an opportunity to play a role in providing compassionate, quality care that makes a difference in the lives of our patients and promotes joy throughout our communities.

Job Description:

  • Responsible for ensuring that all professional services billing audits and projects identified on the schedule established by the Internal Audit Manager are managed within the expected timelines, priorities are appropriately adjusted for unplanned reviews, and post-audit education meetings are conducted with each individual provider to share findings. Individualized post-audit meetings should be conducted within timeframes specified in Audit Program policies and procedures.
  • Conducts internal compliance audits of medical documentation, coding and supporting claims that are billed to third parties to ensure compliance with applicable coding and billing regulations. Prepares detailed reports for the Internal Audit Manager to include audit results and recommendations for improvement.
  • Ensures that the educational needs surrounding documentation compliance of each billing professional is met through effective identification of compliance issues, new provider orientation, and that the organization provides the appropriate training opportunities to resolve issues. Provides ongoing training to providers to ensure their documentation supports the level and acuity of services billed.
  • Available to physicians, APCs, management, and staff for questions related to coding (e.g. surgical procedures, modifiers, documentation requirements). Solicits clarification from physician or provider regarding ambiguous or conflicting documentation.
  • Works collaboratively with Internal Audit Manager to investigate complex coding compliance concerns, research coding and/or documentation questions, and provide education to physicians, APCs, and/or staff as requested.
  • Available upon request to personally perform special (non-routine) audits and share findings as directed. Provides post-review analysis and training.
  • Responsible for billing and coding compliance investigations originating from internal or external sources, compiling supporting documentation for results and proposed action plans to address potential areas of improvement and/or non-compliance.
  • Manages prospective and/or retrospective inpatient and outpatient professional and/or technical documentation audits of professional and/or technical component billing. May analyze or validate routine chart audits performed for multiple specialties.
  • Promotes effective compliance communication, use of the Compliance Hotline, heightened awareness of BH Standards of Conduct, and emphasize the importance of continuing education and training. Promotes awareness of the corporate compliance program educational requirements.

Minimum Education, Training and Experience Required
  • Graduate of an accredited discipline-specific program or BS/BA in Healthcare Administration or Business Administration or equivalent experience required.
  • Minimum of 6 years work experience required in physician billing/reimbursement, billing compliance, and/or Auditing.
  • Minimum of 5 years work experience in auditing and educating individuals regarding medical record documentation in a multi-specialty setting is preferred.

Requirement skill set includes:

  • Certified coder, ideally with AHIMA which is more hospital-focused;
  • Deep understanding of hospital-related workflows, department structure, clinical resources (i.e., might have past experience in medical records department or other clinical area);
  • Auditor experience in the developing evidence and understanding clinical documentation to complete audit process;
  • Candidate will enable to work independently,effective communicator, detail oriented to explain issues to hospital leaders at all levels, and excellent business writing skills;
  • Willing to travel among the facilities including Kentucky and Indiana hospitals in order to complete an assigned audit;
  • Able to stay overnight in area to complete audits as required.

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!

Employees will be expected to comply with Baptist Health's infectious disease and vaccination policies, which include but may not be limited to compliance with BHS' mandatory vaccination policies for influenza and COVID unless reasonable accommodations are needed under applicable law

Baptist Health is an Equal Employment Opportunity employer.
"EEO Statement: Baptist Health is an Equal Employment Opportunity employer, and seeks to employ individuals without regard to race, color, national origin, gender, sexual orientation, gender identity, age, disability, marital status, citizenship status, military status, religious or political beliefs, protected veteran status, employment status or any other protected class identified in any federal, state, or local law. Baptist Health specifically encourages minority, female, disabled, veteran and other candidates from diverse backgrounds to apply and strengthen our team. Please note that Baptist Health is a drug-free workplace and employment with Baptist Health is subject to post offer, pre-employment drug testing.

NOTICE OF NONDISCRIMATION AND ACCESSIBILITY TO SERVICES
Persons with hearing and speech impairments can contact Baptist Health facilities by using the Kentucky Relay Service, a toll-free telecommunication device for the deaf (TDD). For voice to TDD, call 800.648.6057. For TDD to voice, call 800.648.6056."


 

Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
6+ years
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