Compliance Auditor, Intermediate

Description - Internal

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

Under the direction of the Manager of Compliance, the Compliance Auditor, Intermediate 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. This position is primarily located onsite but 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:

• 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.
• 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.
• Conduct audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy.
• Develop concise and well referenced audit workpapers.
• Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.
• 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.
• Maintain current knowledge and understanding of regulatory trends and changes in coding policy and reimbursement methods.

Qualifications - Internal

• High School Diploma or equivalent required.
• Associates Degree or comparable technical school diploma is preferred.
• 3 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.
• 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.
• 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.

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