Role OverviewAs the Principal Compliance Audit Specialist with Alameda Health System, you will be responsible for completing audit documentation requests to assess compliance with federal and state guidelines and other compliance-related requirements.
You will work with leaders and employees to provide education and training to increase and strengthen health care providers’ awareness and understanding on a variety of compliance-related topics, including medical record documentation guidelines and coding principles.
You will also develop and disseminate educational reference guides, cheat sheets, and advisories.Come make a difference in your communityResponsibilities1.
Performs oversight of inpatient and outpatient coding audits, investigations, inquiries and correspondence as needed from key stakeholders; performs inpatient or outpatient coding related audits and reviews.2.
Reviews the electronic health record to identify potential coding & billing compliance issues, based on CPT-4, HCPCS, ICD-10-CM/PCS coding rules, AHA Coding Clinics, Medicare conditions of payments (NCD/LCDs), Medicare Benefits and Claims Manual; performs quality reviews on medical records by validating assignment accuracy of E/M coding rules, CPT-4 and HCPCS codes, and ICD-10-CM/PCS.3.
Evaluates the quality of clinical documentation and monitors the appropriateness through physician education and feedback and achieve accurate coding to support the optimal allowable reimbursement.4.
Prepares and composes all findings and recommendations in a summary report and facilitates communication to the key stakeholders.5.
Partners with System Management (Revenue Cycle, HIM, Case Management, Quality, etc.) in support of developing standardized documentation, medical necessity, coding and billing policies and guidelines, and other educational materials6.
Analyzes and assesses risks with billing and coding rules and regulations based on CMS, OIG Work plan, Medi-Cal program guidelines, Industry Experts, etc.; analyzes inpatient and outpatient data and reviews patterns and trends to identify potential risk areas.7.
Performs other duties as required.QualificationsAny combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.Required Education: High School diploma or equivalent.Preferred Education: Bachelor’s degree in related field.Required Experience: Seven years of direct coding, compliance and auditing experience.
; Five years of Inpatient or Outpatient coding and documentation auditing or active coding experience in the following coding systems: E/M coding rules, CPT-4, HCPCS, ICD-10-CM/PCS.Preferred Experience: Experience training physicians.Required Licenses/Certifications: AAPC Certified Professional Coder (CPC) or Certified Inpatient Hospital/Facility (CIC) or AHIMA’s Certified Coding Specialist (CCS) or Certified Documentation Improvement Practitioner (CDIP).Preferred Licenses/Certifications: Certified in Healthcare Compliance (CHC).
Legal and ComplianceInternal Audit & ComplianceFull TimeDayAdmin, Business & Clinical SupportFTE: 1