Specialist – Audit & Compliance
Full Time, Days
Under the direct supervision of the Healthcare Internal
Audit Manager, the Senior Healthcare Internal Auditor/Senior Regulatory Billing
Auditor is responsible for comprehensive medical audit review and analysis of
clinical and technical records to support acceptable and compliant charging,
billing and documentation practices at the MaineHealth system.
Working independently, the Sr. Healthcare Internal Auditor
will understand and follow Maine Health’s systematic auditing process to
examine and ensure organizational accuracy within the confines of the Federal
and State laws, regulations, policies and procedures. Upon audit completion,
the candidate will be expected to provide statistical reports of findings and
appropriately analyze these findings in the form of an executive summary to the
Department or Program Chiefs, Medical Record Services, Patient Accounts and
other key senior and executive leaders.
The auditor will further be expected to present the analysis
and recommendations that are used to evaluate compliance with the relevant
healthcare regulations and provide technical and educational assistance to
various staff to ensure related process improvement. The Senior Healthcare Internal Auditor may be
asked to a mentor Healthcare Internal Auditors within the department.
Five years' auditing experience required
DRG validation experience a plus
- AHIMA- RHIT, CCS, CCS-P; AAPC-CPC, CPC-H, CPMA;
HCCA- CHC and/or clinical experience as an RN or LPN with the expectation of earning
a certification within 1 year.
- 5 years’ experience with broad knowledge of
medical terminology, anatomy and physiology, pathophysiology and disease
- In depth knowledge of hospital organizations and
- Knowledge of physician billing practices, CMS
billing regulations, CPT coding guidelines from the American Medical
- Ability to establish and maintain effective
working relationships with physicians, subordinates, administrators,
supervisors, outside agency personnel, and all levels of hospital personnel in
relation to appropriate documentation practices and compliance.
- Ability to direct the processing, collection,
maintenance and analysis of compiled information and the preparation of reports
from this data.
- Ability to maintain confidentiality in the
performance of duties.
- Ability to analyze data and interpret it to
- Ability to work independently and self-directed.
apply please click here
or visit www.careersatmainehealth.org.
With a career at any of the MaineHealth member
organizations, you’ll be working with healthcare professionals who truly value
the people around them – within both the walls of the organization and the
neighborhoods that surround it. We are deeply invested in the wellbeing of our
communities and employees. We believe in fostering a work environment of strong
commitment, compassionate caring and continuous improvement. Our care – and the
science behind that care – are top rate. Join us and your abilities will be
challenged and enhanced as you take your career to another level.
As part of our dedication to operational excellence, we
continually invest in technology, innovation and exceptional people in order to
deliver on our promise to the people of northern New England. This includes the
Shared Health Record initiative, which has changed the way we deliver
healthcare within the state. We believe the electronic health record is a
necessary tool in the improvement of healthcare delivery and outcomes. Our
investment in the technology to support the electronic health record is nothing
short of monumental. This means you’ll have the technology necessary to always
ensure an optimal patient experience.
diversity and is an Equal Opportunity/Affirmative Action employer. Federal and
state laws prohibit discrimination in employment because of race, color,
national origin, religion, age, sex, sexual orientation, disability or veteran