Consultant - Healthcare Compliance Auditor - HTS

The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at the Consultant level.

HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents.  This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization.

The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include working with team to develop audit specifications, expert analysis of healthcare claims and supporting documentation, quality control, and development of client deliverables.

The work of a Consultant involves execution of engagement work streams that may be either qualitative or quantitative in nature, and responsibilities include: billing and coding audits, compliance program review, quality control, development of client deliverables, and industry research.

This specific position will require knowledge of medical coding and compliance, and potential candidates must have medical auditing expertise. Job title and compensation to be determined based on qualifications and experience.

Job Responsibilities:

* Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
* Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance
* Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines
* Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement
* Serve as a subject matter expert on interpretation and application of coding and documentation guidelines
* Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas
* Stay current on coding guidelines.
* Develop analyses using transactional data and/or financial data
* Generate client deliverables and make valuable contributions to expert reports
* Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions
* Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting
* Prioritize assignments and responsibilities to meet goals and deadlines.

Qualifications:

* 4-year degree (BS or BA)
* Active coding certification from either AAPC (CPC, CPMA) or AHIMA (CCC-P, AOC) is required;
Do not desire risk adjustment certifications (CRC, RAC) or experience.  Do not desire inpatient hospital certifications (CIC, CCS) or experience.
* Preference will be given to candidates that are certified in medical auditing.
* 2+ years of work experience with a focus on healthcare provider billing and coding;
Less than 10 years preferred.
* Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs).
* Preference will be given to candidates that have previously worked in a consulting firm environment in which their duties included auditing providers or providing audits associated with transactional diligence.
* Preference will be given to candidates who have worked in a role at a health plan auditing and reviewing providers in that plan’s network.
* Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation.
* Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements.

Required skills include:
* Demonstrated ability to interpret…