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Physician Auditor - Compliance

Req Number: 49534 Job Details: Job Summary: Establishes effective working relationships and builds credibility within the Steward entities to support a culture of compliance. Responsibilities: Identifies potential risk areas and assists the Steward entities with developing risk mitigation and/or corrective action plan strategies. Under the direction of the Executive Director, Compliance & Privacy Operations, acts as a consultative resource on issues concerning billing compliance, and provides recommendations to enhance policies, procedures and internal controls as needed. Plans and performs compliance audits of individual physicians, mid-level practitioners and nurses on documentation, coding and billing requirements and related education activities as assigned. Assists in performing other compliance audits as requested. Produces well-written, accurate draft auditreports for review by the Director, Revenue Integrity Audits on a timely basis. Assists with quality assurance peer review of other team members audit work as assigned. Provides recommendations to improve documentation, coding or billing practices, correct any discrepancies discovered during audits, and prevent reoccurrence. Assists with the development and delivery of compliance training programs as assigned. Logs identified issues in the OCCP database accurately and timely. Works collaboratively with appropriate Steward workforce members to resolve compliance issues as assigned. Monitors the implementation status of management's corrective action plans in response to identified compliance issues as assigned. Assists with investigations of compliance concerns at the assigned Steward entities that are raised through the Compliance Support Line or other communication mechanisms. Qualifications: Bachelor's degreerequired or at least 5 years of coding/auditing experience. Minimum of 5 years' experience in a health care. Prior experience as a compliance auditor and education instructorpreferred. Certified Coding Specialist--Physician-Based (CCS-P) or Certified Professional Coder (CPC) required. Additional specialty coding certifications (e.g., Evaluation and Management, Emergency Department, etc.) desired. Microsoft Outlook, Word, Excel, Internet Explorer and PowerPoint Skills Required. Microsoft Access Skills preferred. Ability to effectively navigate electronic health records and physician billing systems is required. Ability to research applicable Medicare, Medicaid and other compliance requirements is required. Must have a valid driver's license, provide own transportation, and be able to travel to Steward locations
Salary Range: NA
Minimum Qualification
5 - 7 years

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