Job Description
Join UPMC Corporate Compliance as an Intermediate Compliance Auditor! Are you passionate about ensuring accuracy and compliance in healthcare documentation and billing? Do you thrive in a dynamic environment where your expertise can make a significant impact? UPMC Corporate Compliance is seeking a dedicated and detail-oriented Intermediate Compliance Auditor to ! This position will be based out of Forbes Tower in Pittsburgh, PA. This is an onsite position with the potential to work from home. Key Responsibilities:
Comprehensive Auditing:Conduct UPMC-wide audits to ensure medical record documentation supports the services coded and billed in accordance with state and federal regulations.
Code Validation:Validate ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting. Regulatory Compliance:Conduct audits on various compliance topics to evaluate adherence to state and federal laws, regulations, and policies. Reporting:Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations. Stakeholder Communication:Communicate audit findings and corrective actions to key stakeholders.
Leadership Advising:Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations. Knowledge Maintenance:Stay current with regulatory trends and changes in coding policy and reimbursement methods. Why UPMC? At UPMC, we are committed to fostering a culture of compliance and excellence. As an Intermediate Compliance Auditor, you will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations.
Join us and be part of a team that values your expertise and dedication to making a difference in healthcare compliance. and take the next step in your career with UPMC Corporate Compliance! • High School Diploma or equivalent required. • Associate's degree or comparable technical school diploma is preferred. • 3 or more years of experience in medical coding, billing, auditing and compliance. • Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
• Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes. • Experience in an academic medical center setting is strongly preferred. • Proficiency with associated technology solutions such as bolthires Excel, Word and PowerPoint is strongly preferred. • Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily. • Must have strong interpersonal, organizational, analytical and communication skills.
• Ability to work in a fast-paced environment. • Must have ability to manage multiple tasks and projects and forge strong interpersonal relationships within the department and with other departments. • Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential. • Experience researching and interpreting regulation and performing internal investigations is essential. Licensure, Certifications, and Clearances: One of the following is required: • Certified Coding Specialist (CCS) • Certified Inpatient Coder (CIC) • Certified Evaluation & Management Coder (CEMC) • Certified
Professional Medical Auditor (CPMA) • Certified
Professional Coder (CPC) • Certified Medical Coder (CMC) • OR Registered Health Information Administrator (RHIA) • Registered Health Information Technician (RHIT) • OR Licensed
Professional Nurse (LPN) • Registered Nurse (RN) Required: • Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran Apply tot his job Apply tot his job Apply tot his job
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