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COMPLIANCE AUDITOR Job in durham, North Carolina

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Employer:Duke Health System
Specialties:Facility Coding Experience
Preferred Certifications:RHIA,CCS,Coding certification (e.g. CPC,CHC,or RHIT)
Required Experience:3 to 4 years
Preferred Experience:3 to 4 years
Location:201 Trent Drive durham 27705, NC, US
Date Posted:1/14/2021

General Description of the Job Class

Conduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, coding, documentation and billing.  Interpretation of applicable federal and state law & regulations to plan audit parameters, determine department’s compliance with such regulations and communicate to department necessary changes in compliance with regulatory requirements.  As well as, manage health system wide response to governmental audits to ensure data integrity and completeness of records and accuracy of claims. 


Duties and Responsibilities of this Level:

- Responsible for conducting compliance audits, documenting & communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within DUHS


- Manage activities related to monitoring requests and responses of governmental audits (e.g. RAC and Medicaid Program Integrity), monitor and trend activity, and oversee and monitor appeals.


- Conduct risk assessments and preparation of work plans.

- Develop an understanding of the operations, system processes and procedures used in areas being audited.


- Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents and investigation of irregularities and errors.


- Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.


- Develop recommended corrective actions to address issues detected.

- Actively participates in exit conferences, providing clarification and supporting information necessary.

- Performs other related duties incidental to work described above


Preferred Qualifications at this Level:

Education: Bachelor’s degree in business administration, accounting, management, healthcare administration, nursing or other related degree or experience equivalent to a four-year degree.


·         Experience with compliance auditing

  • Experience independently performing and conducting compliance audits including the review of documentation, coding and billing.

·       Experience in clinical research, familiarity with protocols, clinical trials and clinical research studies is beneficial.

·     Experience with Federal auditing process and regulations, including billing, coding and documentation requirements.

·     Demonstrated experience working as part of the interdisciplinary team.

·         Experience with EPIC is preferred.

  • Research, abstracts and communicates Federal, State and payer documentation, billing and coding rules and regulations; stays current with Medicare and Medicaid rules and regulations, CPT, ICD, HCPCS, DRG and APC coding updates related to clinical research and serves as a subject matter expert.

Degrees, Licensure, and/or Certification:

Coding certification (e.g. CPC, CCS, CHC, RHIA, or RHIT)

Knowledge, Skills, and Abilities:

Ability to be flexible, multitask, and switch priorities as well as work comfortably in a deadline driven / productivity environment   

Ability to prioritize, organize, plan, and implement services as well as handle multiple projects/problems simultaneously


Strong written and verbal skills are required.


In depth knowledge of federal regulations around clinical trials


EPIC and Microsoft Office experience preferred



Distinguishing Characteristics of this Level:


Required Qualifications at this Level


Work requires a general business background generally equivalent to a Bachelor's degree in business administration, accounting, management, healthcare administration, other related degrees.


Experience: 4 years of experience related to legal, regulatory compliance, or a supervisory role in patient financial services or HIM services.


Degrees, Licensure, and/or Certification:



Knowledge, Skills, and Abilities:

Knowledge of billing compliance, knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.

Coding certification (e.g. CPC, CCS, RHIA, RHIT) or applicable experience is preferred. 

In-depth knowledge of federal regulations

Strong oral and written communication skills.


Distinguishing Characteristics of this Level





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