Compliance Auditor OC Anaheim, CA
The Compliance Auditor is responsible for partnering with local and regional medical center physicians and operations staff to oversee the quality and accuracy of outpatient coded clinical and administrative data, and to work with Regional Compliance to develop and implement an SCAL Compliance Plan that meets federal and other regulatory standards. The Compliance Auditor is also responsible for synthesizing local and regional audit findings to provide actionable feedback to local administrators and physicians on areas for improvement - this position is expected to use independent judgment and sensitivity when educating physicians on appropriate coding and medical documentation. This position is also expected to identify other review methods to assess coding quality (than traditional coding audits and review) than result in faster feedback to local operations staff and physicians. This position is expected to become an active participant in local and regional continuous quality improvement processes and workgroups, with a strong partnership with the Compliance Analyst , Data Quality Specialists and other medical center analytical groups.
- Assure compliance of operational processes and outpatient encounter data capture throughout Southern California Kaiser Permanente making determinations with respect to appropriateness of documentation, adherence to Federal, State and local regulations.
- Partners with ECS DQS's to review regional and local audit findings to identify coding risk areas, and ensure that medical center training activities are addressing these areas.
- Identify through focused audits operational and regulatory issues related to coding, documentation, and compliance reguirements, ensuring that appropriate documentation is maintained to comply with Federal and State requirements.
- Partner with Compliance Analyst, DQSs and other local analytical workgroups to identify audit trends and risk areas based on audit findings and data analysis - formulate recommendations for future training and areas of education and focus based on findings.
- Using independent judgment and sensitivity, review with individual physicians their audit findings and make suggestions for coding improvements.
- Monitor coding performance to ensure lasting improvement.
- Monitor corrective actions for audit review findings.
- Conduct confidential audits for specific providers who represent a risk due to special circumstances or prior audit issues - work with medical center leadership to provide confidential feedback on an 'as needed' basis.
- Actively participate in local ECS Oversight Committee and ECS champion physicians to work to resolve local coding issues, ensure compliance with local and regional audit plan and act as communication link regarding changes to federal and state government billing and coding guidelines.
- Prepare and/or perform regional and medical center auditing analysis and/or special projects as assigned.
- Assists in developing and implementing policies and procedures/Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.
- Bachelor's Degree or equivalent experience in Finance/Business, Medical Records Technology, Health Services Administration, Nursing or other Ancillary medical area.
- Certification in one of the following: i.e. Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), and three (3) or more years coding experience.
- Demonstrated ability to review analytical, data and audit findings to identify coding trends and risk areas.
- Ability to develop data requirements and work with Compliance Analyst and other analytical groups to extract, organize and analyze coded data.
- Demonstrated ability to work independently with minimal supervision, including willingness to be flexible depending upon department and/or physician schedule needs.
- Demonstrated ability to constructively and sensitively provide feedback to physicians and medical center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas.
- Audit skills and the ability to interpret and apply Federal and State regulations, coding and billing requirements.
- Demonstrated ability to effectively work within a team environment, using excellent written, verbal and presentation skills to share audit findings, risk areas and compliance issues.
- Strong interpersonal and excellent written and oral communication skills.
- Ability to work with and maintain confidentiality of physician, patient, patient account, and personnel data.
- Must be able to work in a Labor/Management Partnership environment.
- Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex healthcare issues preferred.
- Medical center operations or clinical experience preferred.
- Computer experience in MS Word and Excel.
- Data entry skills.
- Must be available to work flexible days and hours.
- Travel between all Medical Center facilities may be required.
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