Revenue Cycle Compliance Auditor

Overview: Performs compliance audits and investigations with a primary focus on revenue cycle by reviewing medical records for documentation compliance for CPT, Level II HCPCS, diagnosis codes, and claims to determine compliance with regulations as evidenced in medical record documentation; and evaluating appropriateness of billing and coding procedures. Requires knowledge of CPT, Level II HCPCS, diagnosis coding, claims review, and government payer regulations. Work involves actively directing and conducting compliance audits, investigations, corrective action plans, regulatory research, workforce education, and providing consultative services to the organization’s senior leadership, providers and staff; providing key contributions to the development of the Corporate Compliance annual audit work plan, awareness and mitigation of revenue cycle risks; and providing training and coaching to staff. Maintains and promotes all organizational and professional ethical standards. Works autonomously under general supervision with considerable latitude for initiative and independent judgement.
Independently completes assignments, manages audits and projects, performs regulatory research, investigations, participates and collaborates in the claims review process, providing documentation and compliance educational sessions to senior leadership, clinical staff, providers, revenue cycle leadership and staff, auditing and monitoring the quality and data integrity of Fairview’s coding, documentation and billing practices.
Communicates and interacts with a wide cross-section of executive leaders, directors, managers, providers and front-line workforce to fulfill job requirements.Responsibilities/Job Description:

• Ability to define audits, identify potential risk areas, create transparency with operations, understand operational workflows, develop appropriate action plans, document findings, draft reports and communicate results to leadership (within minimal oversight).
• Liaise with Operations to ensure audit findings are remediated and action plans are sustained and to identify emerging risks.
• Apply judgment to ensure compliance with coding, documentation, and billing laws, regulations and guidelines that govern Fairview Health Services to safeguard, protect and disclose against fraud, waste and abuse while receiving appropriate reimbursement for the care provided.
• Conducts investigations, interviews, reviews documents, and summarizes and documents key issues and ability to communicate results effectively to front-line workforce to senior leaders.
• Skill in conducting audits and reviews by using strong critical thinking skills, operational workflow knowledge, ability to research, as well as negotiation skills.
• Evaluate practice patterns, data-mining, analyze and present oral and written conclusions to leadership and departments in applying and improving compliance and internal controls.
• Provide on-going monitoring, as needed.
• Excellent ability to sustain focus and attention to detail.
• Strong ability to problem solves and assess potential risks identified, prioritize concerns, and provide educational needs to various skill levels, such as physician, ancillary, nursing, coding and billing workforce.
• Considerable knowledge of and skill in applying and educating on federal and state rules and regulations, coding and billing principles and practices (i.e. AHIMA, AMA, Federal Register, CMS, OIG).
• Act as a resource for documentation, coding, claim review process, and billing questions by staying current with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and websites to maintain revenue cycle knowledge.
• Effectively work with and coordinate the activities of external consultants and legal counsel as assigned.
• Advanced written and oral communication and presentation skills a must.
• Participates on committees representing compliance.

Qualifications:
Required

• Bachelor’s Degree or 5 years of coding or auditing experience
• 5 years of coding or auditing experience
• Registered Health Information Administrator (RHIA) Registered Health Information Technician (RHIT), Coding Certification through the AAPC or AHIMA
  

Preferred

• 2 Years Compliance Auditing Experience.
• Data analytics software experience.
• Experience navigating an Electronic Medical Record System.

This position requires remote work. In addition to adhering to all Fairview policies, guidelines, procedures, the Fairview Commitments, and the Code of Conduct, it is the expectation the following requirements of the remote work policy will be met, including but not limited to:

• Remote workspace that is clean, safe, and professional.
• Maintains an internet connection consistent with Fairview standards at remote workspace.
• Remain productive and responsive during their scheduled work hours.
• Attend primary Fairview location, as needed.