About the role
We Do Consulting Differently
The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS is currently seeking a Healthcare Compliance Auditor at the Consultant level.
HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization.
The work of a Healthcare Compliance Auditor will involve execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid.
Job Responsibilities:
Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance
Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines
Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement
Serve as a subject matter expert on interpretation and application of coding and documentation guidelines
Qualifications:
4-year degree (BS or BA)
Active coding certification from either AAPC (CPC, CPMA) or AHIMA (CCC-P, AOC) is required; Do not desire risk adjustment certifications (CRC, RAC) or experience. Do not desire inpatient hospital certifications (CIC, CCS) or experience.
2+ years of work experience with a focus on healthcare provider billing and coding; Less than 10 years preferred.
Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation.
Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements.
Consultant Salary Range: $70,000 – $150,000
Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship.
About BRG
BRG combines world-leading academic credentials with world-tested business expertise and purpose-built emerging technologies. Our culture centers on agility and connectivity which sets us apart and gets you ahead.
Minimum requirements
- Bachelor’s degree (BS or BA) and active coding certification from AAPC (CPC, CPMA) or AHIMA (CCC-P, AOC)
- Minimum 2 years healthcare provider billing and coding experience, under 10 years preferred
- Comprehensive knowledge of Medicare rules and advanced CPT-4, HCPCS, ICD-10-CM coding systems and guidelines
This listing was parsed by AI and may not be complete. Check the official posting on BRG's site for the most accurate information.