Summary/Objective
The Auditor serves as a liaison on behalf of the practice and patient as well as the practice and outsourced RCM providers. They are responsible for reviewing professional fee billing, coding and other documentation, as well as auditing physician billing practices against documentation in the medical record to ensure compliance with all federal, state, and third-party billing requirements, rules and regulations.  

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Perform reviews/audits based on the current OIG Workplan and compliance risk analyses:

· Perform timely and effective compliance and operational reviews to assess coding, documentation and billing accuracy

· Identify compliance risks and revenue capture opportunities 

· Determine corrections and refunds resulting from compliance audits and ensure they have been completed

Analyze and identify areas for documentation improvement:

· Prepare written reports

· Provide education and training as needed

· Follow-up reviews when necessary

· Communicate findings and provide recommendations for improvement when needed

Keeps up-to-date with governmental, state and payer-specific rules/regulations that pertain to documentation, coding and billing to audit charts and billing.

Field questions from other coworkers and staff regarding coding and compliance issues.

Competencies

· Strong knowledge of coding disciplines 

· Strong knowledge of medical terminology, medical billing and payment methodologies, including coding guidelines for ICD-10, CPT, HCPC, E/M, etc.

· Comprehensive knowledge of procedure and diagnostic coding for professional services and Medicare, Medicaid and other third party-payer coding and billing regulations

· knowledge of 1995 and 1997 Evaluation and Management Documentation guidelines and other professional documentation requirements

· Excellent verbal, written, and interpersonal communication skills

· Strong computer skills including MS Office (e.g., Excel and Word)

· Ability to multi-task and set/meet multiple deadlines under pressure with initiative, diplomacy, and calmness

· Knowledge and understanding of HIPAA rules and regulations

Supervisory Responsibility

None

Work Environment

This position is fully remote, but you must reside in one of the following states: Pennsylvania, Maryland, New Jersey, Delaware, Texas, Tennessee, West Virginia, Indiana, Georgia, Florida, Ohio. 

Physical Demands

The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Position Type/Expected Hours of Work
Full Time with an 8-hour shift  / Monday – Friday

Travel

None

Work Authorization/Security Clearance 

Must be authorized to work in the US for any employer

AAP/EEO Statement 

US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

 Coding certifications (AAPC or AHIMA) and (CPMA) required