Compliance Auditor - Physician Auditing

Compliance Auditor

Corporate Compliance

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization, passionately dedicated to improving the health and well-being of our community.  With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to the comforting embrace of home healthcare, with a unique range of specialized medical services, including cancer, heart health, maternity, and mental wellness.

When you join the LMHS team, you become a vital part of your local community Hospital.  Working at LMHS is not just a job, it is a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors.  You will be providing care in a place in which you are personally connected, where the impact of your work extends beyond the Hospital doors and into the heart of our community.  Our commitment to diversity, equity, and inclusion ensures that every member of our community is served with respect and compassion.  Join us in our mission – dedicated to patient safety, utilizing state-of-the-art technology, and with a passionate team of highly trained and compassionate individuals who strive to improve the health of the community.

Position Description

Under the general direction of the Vice President of Financial Services, this position provides overall compliance auditing and monitoring functions of the Licking Memorial Health Professionals physician practices. This position additionally serves as a liaison for regulatory and billing purposes with the LMHS Medical Staff, the physician corporation staff, Professional Billing and Health Information Staff.

Responsibilities

• Primary focus on the compliance of the physician corporation coding and documentation practices. 


• Responsible for internal auditing and monitoring of procedure and diagnosis coding to assure consistency with federal and state law.  Collaborates with other departments as needed.


• Responsible for auditing charge capture process, coding and billing processes, and assisting in resolution of case or system failures.


• Provide consultation in the application of process improvement principles as they relate to the results of the compliance audit functions and findings.


• Provide expertise to departmental personnel and medical staff in the areas of coding, billing and compliance with applicable input from the Corporate Compliance staff.


• Effectively work with multi-disciplinary groups, skilled at interacting with physicians, nurses, and other health care professionals.


• Effectively analyze problems and develop well-reasoned solutions based on official resources, recognize and validate assumptions, collect information and draw meaningful inferences.


• Effectively maintain confidentiality and a sense of credibility and reliability.

Requirements

• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Bachelor prepared individual with significant coding and auditing skills.


• A minimum of three to five years in health care setting with physician billing, coding and/or reimbursement responsibilities.


• Work requires a comprehensive knowledge of coding (ICD-10-CM and CPT) and HCFA-1500 billing requirements for Medicare, Medicaid and third-party payers.


• Use of personal computers, including application of Microsoft programs, especially Excel and Word.


• Understands auditing and statistical principles and must be able to apply to daily work responsibilities.


• Excellent communication skills at all levels of the organization including staff, management and medical staff.


• Self-directed work habits, attention to detail, and ability to independently manage audit project schedules.


• Not a remote position. 

Licking Memorial Health Systems is an equal opportunity employer and maintains compliance with all state, federal, and local regulations.  Licking Memorial Health Systems does not discriminate against applicants because of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors protected by law.