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COMPLIANCE AUDITOR Job in Tampa, Florida

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Employer:Moffitt Cancer Center
Job Location:Remote
Required Certifications:CCS-P,or RHIA,COC,AHIMA,etc.,CCS,AAPC,CPC
Preferred Certifications:AAPC or AHIMA
Required Experience:3 to 4 years
Location:12902 Magnolia Drive Tampa 33612, FL, US
* Note: This listing is for a remote position
Date Posted:7/26/2021

Position Highlights:

Compliance Auditors conduct Compliance Department audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Audits consist of evaluation of the adequacy and accuracy of documentation in support of services billed, and compliance with other documentation and coding and billing standards.

·         The Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional or hospital documentation, coding and billing, including federal and state regulations and guidelines, CMS and other third party payor billing rules, and OIG compliance standards.

·         The Compliance Auditor communicates audit results to physicians, physician leadership, senior management, management, and staff; provides physician and coder education; and make recommendations for corrective action to leadership, faculty, coders, billers and other appropriate staff.

·         The Compliance Auditor will act as a liaison with assigned faculty members, developing relationships and functioning as a resource to all providers and their staffs. He/she will serve as an institutional subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, medical necessity of services delivered, and conduct enterprise risk assessments of potential and detected compliance deficiencies.


The Ideal Candidate:

·         Professional and/or hospital services auditing experience in an Academic Medical Center.

·         Prior experience working in a Corporate Compliance environment.

·         Prior experience working in a Cancer Hospital.

·         Prior experience working in a Revenue Cycle Operations role.

·         Knowledge of Soarian and/or Soarian PRM applications.

·         Knowledge of Cerner Powerchart applications.



·         Plans and performs scheduled and unscheduled professional or hospital compliance department audits, including accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.

·         Evaluates the appropriateness of services and procedures billed based on supporting documentation.

·         Prepares written reports of audit findings and recommendations and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.

·         Conducts risk assessments to define audit priorities by evaluating previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best practices.

·         Develops compliance training content; provides one-on-one and group training to faculty physicians, advanced practitioners, billing and coding staff and others to ensure compliance with federal and state regulations and laws, CMS and other third party payer billing rules and internal documentation, coding and billing policies and procedures. Conduct compliance orientation training for new providers one-on-one or in a group session.

·         Researches, abstracts and communicates federal, state and payer documentation, billing and coding rules and regulations.  Serves as institutional subject matter expert and authoritative resource in these areas.


Credentials and Qualifications:

·         Bachelor's degree in Health Information Management, Business or related field**In lieu of a Bachelor's Degree, HS Diploma/GED and seven (7) additional years of relevant experience will be considered

·         Must possess an AAPC or AHIMA coding certification (CPC, CCS, CCS-P, COC, or RHIA, etc.)

·         Three (3) years of experience in physician and/or hospital technical coding/auditing, medical necessity reviews, or related work.

·         Extensive knowledge of evaluation and management and/or hospital facility fee coding and auditing.

·         Knowledge of Medicare and Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; charge capture and reimbursement methodologies; medical terminology; E/M rules, teaching physician guidelines, and/or medical necessity defense reviews; healthcare compliance audit methodology, principles and techniques; CMS manuals; professional and/or hospital services reimbursement and repayment; confidentiality standards.

·         Ability to interpret and apply documentation and coding rules and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation.

·         Strong attention to detail and analytical skills, and the ability to interpret new laws and regulations, and communicate effectively both verbally and in writing.

·         Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties.

·         Ability to work in both independent contributor and team roles (both as a team leader and team member).

·         Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership. Exercises patience and consistency in approach and communications.

·         Experience working with enterprise databases and analytics.

·         Ability to work pro-actively and collaboratively to fulfill the objectives of the Compliance Program and address matters with credibility, objectivity, and confidentiality in accordance with professional auditing and investigative standards.

·         Ability to abide by the highest ethical standards and exhibit these standards and the Cancer Center's mission, vision, and values in the performance of position duties.

experience working in a Revenue Cycle Operations role.

·         Knowledge of Soarian and/or Soarian PRM applications.

·         Knowledge of Cerner Powerchart applications. 


Go to www.moffitt.org/careers
Req# 46256

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