Dignity Health

  • Sr. Coding Compliance Auditor (Remote or Sac)

    Job ID
    2018-57289
    Employment Type
    Full Time
    Department
    Compliance
    Hours / Pay Period
    80
    Facility
    Dignity Health System Office
    Shift
    Day
    Location
    Rancho Cordova
    State/Province
    CA
    Standard Hours
    Mon-Fri
    Work Schedule
    8 Hour
  • Overview

    Dignity Health, one of the nation’s largest health care systems, is a 22-state network of more than 9,000 physicians, 63,000 employees, and 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved.  In FY17, Dignity Health provided $2.6 billion in charitable care and community services. For more information, please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.

    Responsibilities

    Position Summary:

     
    The Dignity Health Medical Foundation Compliance Office is a comprehensive approach to promoting ethical and proper behavior in all matters related to Dignity Health Medical Foundation's business operations and to establish effective controls that promote adherence to applicable laws, regulations, rules, guidelines, requirements, procedures and directives regarding Federal, State and Private health services.
    • This program implements, and enforces Dignity Health's and Dignity Health Medical Foundation's policies with the goal of minimizing risks associated with billing, and as one method of preventing and detecting inappropriate, improper, and fraudulent conduct.
    • This program establishes Compliance Standards and Procedures to be followed by all Dignity Health Medical Foundation employees and other agents, and provide direct compliance training and training oversight of all training materials.
    • This position reports to the Supervisor of Compliance and is able to work independently and effectively with general supervision.
    • Audit medical records according to the schedule set by the audit team. Verify that sample billing charges for a set period of time and for a specific Provider/Department/Division have been billed accurately, appropriately (correct levels and coding), and in a timely manner. Maintain documentation of audit results. Complete compliance audits and reviews within established parameters.
    • As requested by Director or Manager of Compliance, perform other audits or investigations of various health system operations relative to documentation, billing process, privacy, quality or other functions relating to proper compliance with governmental regulations, laws and policies. Maintain thorough and concise documentation throughout audits and/or investigation with dates, times, names and specific details. Report progress and findings to Manager.
    • Comply with Dignity Health Code of Conduct, Compliance Plan and Dignity Health policies and procedures. Participate in established programs of education and training of Dignity Heatlh providers, staff, and all other appropriate personnel on compliance requirements with applicable laws, regulations and policies.
    • Report unusual and complex issues and situations to Manager for guidance. Recommend action plans to ensure that the function is meeting all expectations of senior management. Suggest process improvements.
    • Performs other duties as assigned.
     

     

    Qualifications

     Minimum Qualifications:
    • 3 years experience in Auditing or Coding in multi-specialty groups or similar related experience.
    • Must possess and maintain certification as a Certified Coding Specialist-Physician-based (CCS-P) from the American Health Information Management Association (AHIMA) or a Certified Professional Coder (CPC) from the AAPC.
    • Ability to perform consultations with departments and medical providers to enhance billing functions, performance, accuracy, documentation requirements, and all other system requirements.
    • Proficient with medical terminology at college level with the ability to understand disease processes, anatomy and physiology necessary for assigning accurate numeric and alphanumeric codes.
    • Experience with and knowledge of instructional notations and conventions of ICD-9-CM, ICD-10, CPT, HCPCS, APC classification systems; the ability to follow the detailed guidelines related to their use in assigning single and sequencing multiple, diagnosis and procedure codes for appropriate the reimbursements and data collection.
    • Proficient in organizing and compiling documentation and thoughts in order to provide supported opinions to the medical providers on audit findings.
    • Ability to develop strong working relationships with others.
    • Strong problem solving skills, ability to manage project tasks and timelines, and analytical ability.
    • Ability to work with, communicate to, and present to a diverse work force in all levels of the organization.
    • Strong computer skills.
    Preferred Qualifications:
    • Knowledge of Allscripts, Cerner and/or other electronic medical records systems.
    • Knowledge of MDAudit. 
    • Experience in auditing medical

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