Allegheny Health Network Careers

Job Title: Compliance Auditor
Date Posted: 08/22/2016
Position Number: 52794

Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities. With more than 17,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.

Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures. Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.

Department: Corporate Services
Status: Full-time
Pay Grade: 90
Non-Union

Job Summary: Plans and conducts medical and billing audits (including hospital outpatient clinics, outpatient procedures, ancillary services), presents audit findings to hospital/ physician leadership, creates appropriate audit spreadsheets, provides educational presentations to hospital departments/physicians/ practice staff as applicable to correct audit concerns; completes special coding billing and documentation audits;. Performs other duties as assigned.

Responsibilities:

• Perform internal concurrent, prospective, and retrospective audits to assure that billed services are supported by documentation in the medical record and that all coding and documentation is compliant with appropriate guidelines and federal and state regulations.
• Perform audits and research related to special projects.
• Develops audit detail summary spreadsheets and reports to address any coding, documentation, or financial discrepancies.
• Conducts educational sessions for hospital/physician staff.
• Conducts presentation of final audit findings to department staff, physicians, and appropriate individuals.
• Performs other duties as assigned or required.

Requirements:

• Bachelor’s Degree required or equivalent education and experience
• Current Driver’s License (as car and travel throughout Western PA) is required
• National certification in procedural coding, certified professional coder (CPC) or (CCS) required; RHIT, or RHIA preferred
• Minimum of 3 years of experience is hospital/physician coding and documentation reviews required. Demonstrated knowledge of Medicare, Medicaid and local third party regulations along with advanced ICD-9 and CPT coding/anatomy/ medical terminology and hospital/physician billing process and medical record audit process.
• Advanced computer skills in applications such as Microsoft Word and Excel along with proficient writing skills, preparation of work papers and reports, and presentation of clear and concise findings (oral and written) are also required