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Healthcare Billing/Claims Compliance Auditor/Analyst

Company: US Radiology Specialists
Location: Garland
Posted on: November 22, 2021

Job Description:

As a member of the Compliance team, the Compliance Analyst will work closely with compliance officers and will conduct all phases of internal coding and claims audits, compliance, operational and/or billing reviews as well as participate in and/or lead process improvement projects. The Compliance Analyst will work with all RCM departments as well as interact directly with operational facilities as needed.

Plano/DFW area, TX
Nashville or Knoxville, TN
Charlotte or Raleigh, NC

Essential Duties and Responsibilities:
Performing all phases of internal coding, billing & documentation audits, operational and compliance audits as directed
Serving on project implementation teams as needed
Working as part of a team who support each other to accomplish set goals and objectives together
Understanding of healthcare audit procedures and internal controls.
Excellent planning, analytical, organizational and communication skills are essential
Participating in coding and reimbursement training programs. Assist Compliance Officer with providing instruction and education to staff on accurate charge entry and medical record documentation.
Collaborating with our internal Compliance Department to resolve coding issues according to national standards through analysis of medical record documentation and use of standard coding rules.
Developing and maintaining professional skills and up to date knowledge of healthcare regulatory and compliance issues related to medical coding, documentation, and billing
Flexible attitude and open to changes in the audit schedule
Absolute attention to detail
Demonstrate ability to manage multiple projects and tight deadlines
Excellent teamwork and interpersonal skills
Demonstrate leadership potential
Strong mission and values commitment; natural cultural fit
- Other duties as assigned.

Minimum Qualifications:

Four-year college degree required (change to preferred?) accounting, finance, business administration, or health care administration preferred
2+ years Healthcare Audit experience required
Certified Professional Coder (CPC) certification preferred .
Required Knowledge, Skills & Abilities:
- 2+ years experience in health care, compliance, or other highly regulated industry
A minimum of 2 years of related experience in Physician or radiology coding with specific experience in Coding Validation and/or compliance review in radiology and/or outpatient imaging services setting preferred
Knowledge of medical terminology, anatomy and physiology, pathophysiology, ICD-10-CM and CPT-4 classification systems, Medicare, Medicaid and regulatory agency requirements related to radiology specialties.
Computer literacy and healthcare statistics computation required.
Excellent written and verbal communication skills in order to effectively deal with conflicting views and issues and mediate fair solutions.
The ability to work with diverse internal and external constituencies.
The ability to take responsibility and perform required tasks independently, as well as in a team environment.
Certification in healthcare compliance preferred
Excellent analytical skills
Excellent communication ability
Strong organizational skills
Ability to manage multiple projects effectively and efficiently
If not already achieved, obtain either of the below certifications within first two years of employment required :
-Certified Healthcare Compliance (CHC) designation
-Certified Internal Auditor (CIA) designation

Keywords: US Radiology Specialists, Garland , Healthcare Billing/Claims Compliance Auditor/Analyst, Professions , Garland, Texas

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