Senior Compliance Auditor

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Department

Job Summary

Under minimal supervision, this position is responsible for conducting audits of clinical documentation, coding, and billing to determine compliance with Federal and State regulations and payer policies and procedures at the direction of the Manager of Compliance Billing Integrity. Provide formal and informal coding and regulatory education to coding staff, attending physicians, residents and non-MD providers.

Essential Functions:

• Coordinate and perform both planned and ad hoc retrospective reviews to ascertain the (1) adequacy of department policies, procedures, and controls over the clinical documentation, coding, and billing processes, (2) reliability and integrity of patient medical record documentation and coding information in support of payer charges, (3) compliance with government regulations, internal documentation, coding, and billing policies and procedures, (4) documentation and coding performance of individual providers, (5) coding performance of individual facility and physician coders, and (6) documentation and coding performance relative to specific legal and regulatory compliance focus areas. (40%)
• Report on the results of completed retrospective reviews. Include facility and/or physician coding within the scope of the reviews. (20%)
• Obtain audit management action plans, develop plans with department management for implementing audit recommendations, track recommendation implementation status and maintain documentation of implementation. (10%)
• Perform and/or provide oversight and guidance of department monitoring activities related to or independent of audit activities. (10%)
• Research and provide guidance on coding, documentation, and billing compliance matters when necessary. (10%)
• Assist in the annual risk assessment process and creation of the annual audit work plan as needed (5%)
• Educate self continuously on Federal and State regulatory requirements (5%)

Education:

• Bachelor's Degree Required and
• Post Graduate Diploma or Certificate Program ICD-10 certification Required

Work Experience:

• 4-6 years Five years' experience in CPT, ICD 10 and HCPCS coding. Required and
• Previous auditing experience preferred. and
• Evaluation and management coding, training/teaching adults and teaching/academic medical environment experience preferred.

Licenses:

• CCS-Certified Coding Specialist - AAPC - American Academy of Professional Coders Required

Knowledge, Skills and Abilities:

• Superior communication skills including oral, written and presentation skills as well as an understanding of the adult education process.
• Knowledge of third party payer reimbursement, coding and documentation requirements and Medicare and Medicaid regulations for Hospital and Physician billing.
• Ability to speak in front of large audiences.
• Self-starter and detail oriented.
• Ability to establish workload priorities and balance diverse projects.
• Proficient in Microsoft Office Suite.
• Working knowledge of Epic.

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.