Healthcare HIM Compliance Auditor
Company: Connecticut Children's Medical Center
Posted on: May 7, 2022
SUMMARYThe Healthcare HIM Compliance Auditor would be
responsible providing assurance through audits and recommendations
that adequate procedures and processes exist to ensure hospital
billing and coding is complete and accurate. This position will
also be responsible for performing risk assessments to identify
compliance and non-compliance concerns. The Healthcare HIM
Compliance Auditor will coordinate with clinical operations,
revenue cycle departments to ensure accounts audited reflect proper
documentation, charge capture, coding, billing and payment. As part
of the Compliance department, the position is also responsible for
educating and promoting compliance with all policies and guidelines
throughout the organization.ROLE RESPONSIBILITIESReporting to the
Assistant Manager of Corporate Compliance of Connecticut
Children's, the Healthcare HIM Compliance Auditor contributes to
the identification and reduction of CCMC's coding compliance risks,
billing inaccuracies, and/or denials by coordinating independent
reviews and assessments of the organization's hospital inpatient
and outpatient and emergency department coding and billing
transactions, processes, and internal controls for coding
completeness and accuracy. The Healthcare HIM Compliance Auditor
evaluates the effectiveness of current billing and coding internal
controls; 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. This position is responsible for identifying potential
coding and billing CPT, ICD-10-CM/PCS, APR-DRG, MS-DRG, and APC
errors, researching appropriate guidelines to support recommended
improvements, and communicating these improvements to Revenue Cycle
Management on a timely basis. The Healthcare HIM Compliance Auditor
provides expert compliance advice and education to coding
personnel, clinical staff and physicians, along with department and
Position Specific Role Responsibilities
- 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,
- Assists revenue cycle departments with identifying risks and
communicates the results to management
- With the Assistant Manager, develops and executes the yearly
objectives for the department.
- Performs education of new providers to compliance, fraud, and
abuse statutes, and the audit process
- Responds to compliance queries put forth by clinical and
non-clinical providers and staff.
- Maintains up-to-date knowledge of industry coding, billing and
documentation guidelines so as to ensure system-wide consistency
and compliance with governmental and other regulatory
- Maintains up-to-date knowledge of healthcare compliance
regulations so as to ensure system-wide consistency and compliance
with governmental and other regulatory guidelines.
- Communicates audit findings with auditees in a timely
- Communicates audit findings with the departmental management
and identifies areas of educational need based on audit
- Maintains an open dialogue and good working relationship with
external auditors, Revenue Cycle, HIM, and Coding Management; and
clinic/department staff and their leadership in order to advance
CCSG and CCMC revenue objectives and goals.
- Responsible for timely completion of Revenue Cycle Compliance
projects and processes
- Assists with training of new auditors.
- Collaborates with other audits and duties as
requested.KNOWLEDGE, SKILLS AND ABILITIES REQUIREDHuman relations
and excellent written and verbal communication skills are
essential. Strong analytical skills, with extensive knowledge of
federal, state, and payer-specific regulations and policies
pertaining to documentation, coding, and billing, with demonstrated
ability to interpret such guidelines.
Demonstrates an advanced knowledge and skill in analyzing patient
records to identify non-conformances. Proficient in the use of word
processing and spreadsheet software, Word and Excel. Excellent
interviewing and report writing skills. Ability to quickly identify
risk, its likelihood and possible impact, root cause, and make
recommendations for risk mitigation. Assumes working knowledge in
the field of health care, revenue reporting and/or reimbursement.
Demonstrates ability to lead groups and work on numerous projects
Work Environment:Clinical and Non-clinical work
environment.Physical Requirements:Amount of Time(Choose which ones
Constant> 75% day
Manual Dexterity/Repetitive use of hands, wrists, arms, elbows
Forward reach w/hands and/or arms
Climb or balance
Stoop, kneel, crouch
Overhead/above shoulder reaching
Choose Applicable Lifting Demands
15 - 25 lbs.
25 - 40 lbs.
50 - 100 lbs.(push/pull only)
More than 100 lbs.*(push/pull on wheels only)
- indicate weight range
Requirements:High School Diploma required; Associate's Degree
Three to five years of HIM coding experience required.
Two to three years of Inpatient, Outpatient, and Emergency
Department coding or auditing preferred.
Professional coding experience additionally is favorable.
Experience working in a Teaching Hospital setting preferred.
Prior experience with billing and claims processing preferred.
Prior experience working in a hospital or clinical setting is
Strong communication and organizational skills.
Proficient in Excel, Word, Epic or other EHR and computerized
health care billing software knowledgeKnowledge of State and
Federal Medicaid and Medicare billing rules and program
Keywords: Connecticut Children's Medical Center, Hartford , Healthcare HIM Compliance Auditor, Healthcare , Hartford, Connecticut
Didn't find what you're looking for? Search again!