Compliance Audit Coordinator; Coder

Compliance Audit Coordinator (Coder) - Full-time with Benefits

Posted 4 days ago, among the first 25 applicants. This range is provided by Frederick Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$58,260.00/yr - $85,737.00/yr

Supports the Corporate Compliance Specialist, coordinates and conducts internal compliance audits to help ensure compliance with applicable statutory and regulatory requirements and organizational policies and procedures. Identifies and resolves operational issues with improvement in the work process. Tracks and trends external audits related to Recovery Audit Contractor (RAC), Certified Error Rate Testing (CERT), Target Probe and Education (TPE), Fraud Waste Abuse (FWA) and other audit requests.
Provides guidance, support, and oversight to the organization ensuring effective management of the audit response process for all payers; coordinates with subject matter experts to manage the appeals of the adverse audit determinations as well as the clinical responses provided by Frederick Health; evaluates data associated with audit activities, tracks and measures the effectiveness to responses received. Assists the Corporate Compliance Specialist to manage, monitor, support, and report on the consistency and adequacy of the system's response to the audit recovery requests.
Supports the Mission of Frederick Health Hospital and complies with the hospital's Standards of Behavior.

• Identifies improper Medicare over payments and underpayments.
• Investigates accounts received under the RAC program and determines if they are appealable, ensuring timely completion and tracking of accounts; updates spreadsheets regularly.
• Coordinates audit projects and develops audit plans and procedures specific to each project.
• Researches, analyzes, and interprets rules and regulations applicable to the audit project.
• Communicates audit findings through written reports and/or meetings with management and staff, as applicable.
• Works proactively with hospital staff and physicians to ensure areas impacted by audits and corrective action plans when deficiencies are.
• Performs follow-up inquiries to assess whether recommended changes were implemented.
• Maintains tables or data in Microsoft Excel or Access Database.
• Understands many complex guides, systems, regulations, and tools; utilizes critical thinking skills to manage an ever-evolving process that includes financial, clinical, and medical/legal components.
• Stays current on trends related to medical necessity, annual code changes, billing and documentation requirements including local coverage determinations (LCD), medlearn matters (MLM).
• Maintains CEU requirements by attending conferences, seminars, and audio conferences.
• Adheres to all patient confidentiality policies and carries out all tasks in a pleasant and respectful manner.
• Suggests enhancements throughout the department and continually seeks opportunities to improve current policies, procedures, and practices.
• Demonstrates responsibility for professional growth and development; organizes workload and prioritizes tasks effectively.
• Assists the Corporate Compliance Specialist with special projects and other job-related duties.

• Bachelor's degree and/or revenue cycle or patient accounting experience.
• CPC, CCS Coding Credential Preferred (AHIMA, American Academy of Professional Coders).

• Exposure to clinical, ancillary/clinical, and finance/business operations.

• Knowledge of rules and regulations pertaining to hospital reimbursement; must have a patient accounting background with fundamental knowledge of revenue cycle processes, including patient access, case management/utilization review, charge capture, HIM, patient accounting.
• Strong attention to detail.
• Analytical, written, and computer skills.
• Knowledge and application of spreadsheet, Word processing, and presentation software.
• Excellent oral and written communication skills.
• Strong organizational skills and ability to prioritize and manage multiple tasks.
• Ability to maintain a…