Billing Compliance Auditor & Educator

Role: 

The Billing Compliance Auditor & Educator is responsible for the development and execution of the Billing Compliance program of Harbor Health. This includes compliance auditing, coding and billing auditing, clinical billing and coding education, as well as compliance program planning and execution. The Billing Compliance Auditor & Educator performs compliance audits, coding and billing audits and serves as a subject matter expert to Harbor Health on issues related to professional coding and billing and general corporate compliance practices. Position will be hybrid and will require some travel to all other health center sites. 

Responsibilities:  

• Coordinates independent reviews and assessments of the organization’s professional coding and billing transactions, processes, and internal controls for coding completeness and accuracy.
• Develops and maintains an effective Billing Compliance Program for the Community Health Center clinics of Harbor Health.
• Evaluates the effectiveness of Harbor Health’s current billing and coding practices, validates compliance with state and federal regulations and internal policy and procedure mandates; and recommends process, procedure, and policy improvements to mitigate against identified risks.
• Identifies potential coding and billing errors, researching appropriate guidelines to support recommended improvements, and communicating these improvements to the Director and Revenue Cycle Management on a timely basis.
• Provides expert compliance advice and education to coding personnel, clinical staff and physicians, along with department and practice management.
• Performs a variety of audits such as: HCPCS, CPT coding, DRG coding, and medical record reviews using scientific methods, statistical processes and proven healthcare audit methodology with a focus on governmental payers, including Medicare and Medicaid.
• Coordinates with clinical operations, health information management and revenue cycle departments to ensure accounts audited reflect proper documentation, charge capture, coding, billing and payment.
• In a timely manner, clearly communicates audit findings with providers, the department managers and identify areas of educational opportunities or required corrective actions based on audit results, exhibits clear concise report writing and presentation skills.
• Conducts follow up education and develops corrective action plans to address audit findings and/or identified risks.
• Responsible for performing risk assessments to identify compliance and non-compliance concerns.
• Coordinates and executes pre and post-payment audits of medical records and associated clinical documentation to ensure proper charge capture and billing in accordance with standard state, federal, and internal reimbursement policies, principles, and mandates.
• Conducts education of new providers on compliance, billing and documentation guidelines, fraud and abuse statutes, and the audit process.
• Responds to billing compliance queries by clinical and non-clinical providers and/or staff while maintaining appropriate degree of confidentiality.
• Maintains up-to-date knowledge of industry coding, billing and documentation guidelines and healthcare compliance regulations to ensure Harbor Health clinic wide consistency and compliance with governmental and other regulatory guidelines.
• Maintains an open dialogue and good working relationship with external auditors, Revenue Cycle, IT, and Compliance Management; and clinic/department staff and their leadership in order to advance Harbor Health’s compliance, audit and revenue objectives and goals.

Requirements: 

• Associate’s degree in related field required; Bachelor’s degree preferred
• Certified Professional Coder (CPC) required or Certified Risk Adjustment Coder (CRC) preferred
• Minimum of 5 years of experience in healthcare billing compliance auditing and education
• Advanced user of Microsoft Office 365 applications including Word, Excel, Outlook and Teams
• Project Management experience or training preferred
• Excellent verbal and written communication skills.
• Able to work compassionately with providers and administrative staff within the practices
• Able to work independently and collaboratively
• Must be able to travel between all Harbor sites in a timely manner

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.