SUMMARY: The Compliance Auditor and Educator will participate in the performance of medical record audits of all College of Medicine Departments involved with billing third-party payers. Will also serve as an educator for physicians, residents, and billing/coding staff regarding coding and documentation requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES may include the following. Other duties may be assigned.
- Perform annual audits of documentation of inpatient and office medical records by physicians, residents, nurse practitioners and other providers.
- Educate the physicians, residents, nurse practitioners and other providers of coding and documentation issues based on the audits.
- Report audit results to the Associate Dean, Compliance Committee, and Board of Directors as appropriate.
- Provide coding and documentation guidelines to the physicians, residents, nurse practitioners, and billing employees as needed.
- Provide an orientation to all new hire physicians on the compliance plan and policies, teaching physician guidelines.
- Research problem areas and provide solutions related to coding and payer requirements.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION AND/OR EXPERIENCE: Knowledge of CPT, ICD-10-CM and HCPCS coding systems and guidelines. Basic knowledge of HIPAA guidelines necessary. Experience in an academic and/or multi-specialty environment. Knowledge of medical terminology, physician billing, third-party regulations and auditing procedures. High school diploma or GED required. CPC or CCS required, plus 3 years of coding and billing experience. CPMA is preferred; this certification would be required to obtain within 6 months of employment. Bachelor’s degree and/or previous auditing experience preferred but not required.
Applicants should apply online at https://etsuhealth.org/employment
