Job DescriptionWhat you will be doing in this role:The Physician Compliance Auditor is responsible for reviewing and auditing claims, medical records, and charges to ensure compliance with applicable documentation, coding, and billing requirements. Works closely with providers and staff to educate and train or provide audit results feedback through the use of Teams or other remote meeting platforms. The Physician Compliance Auditor identifies issues and/or risks associated with documentation, coding, and billing. This position is responsible for maintaining expert knowledge and understanding of coding and documentation guidelines. Collaboration with the Manager of Audit and Compliance and others where expertise in compliant coding and documentation is needed. In this role your duties will include:
- Performs physician compliance audits and group audits by analyzing medical record documentation and coding services to ensure compliance with government and organizational policies and procedures.
- Identifies areas of risk and/or non-compliance and provides recommendations for action - advances as needed.
- Conducts education and training sessions with individual providers on audit finding results, regulatory requirements and provide actionable feedback for improvement.
- Responsible for summarizing audits results and presenting to provider, operations leaders, and other leadership.
- Communicates feedback directly to providers.
- Prepares necessary reports and communicates audit results to management and clinicians.
- Prepares training and education materials acting as subject matter expert.
- Tracks, records, and maintains audit/review activity in software or excel spreadsheets.
- Provides regular and ad hoc reporting.
- Assists with audit & compliance related special projects as requested.
- Maintains a high level of competency related to medical record documentation, coding and compliance with government regulations by attending appropriate workshops and seminars.
- Monitors Medicare and regulatory agencies rules for updates and changes and supports Cedar-Sinai's core values and procedures.
- Acts as a professional liaison for physician compliance related activities, in a professional and confidential manner.
QualificationsRequirements:High school diploma or GED required. Bachelor's degree preferred.
Certified Professional Coder certification required upon hire.
A minimum of 2 years of professional fee coding/auding required, preferably in an academic medical setting.
