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Compliance Audit Specialist (Evaluation and Management) in Spartanburg, SC at Spartanburg Regional Healthcare System

Date Posted: 5/6/2019

Job Snapshot

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Job Description

Position Summary:

Under the direction of the Privacy Officer & Compliance Director and the Senior Compliance Audit Specialists, the Compliance Audit Specialist (CAS), Evaluation and Management (E&M), serves in a consultative role to the organization for all aspects of provider coding, billing and education. The position enhances provider documentation, coding and billing compliance through; auditing, monitoring and analysis of billing patterns, ongoing and routine audits and comprehensive, advisory and educational support. The position operates in partnership with clinical providers, medical directors, leadership, coders and other internal and external customers. By providing oversight and expertise in documentation, coding, billing and regulations, this position is integral to and directly influences the success of the organization's provider billing compliance and the organization's Corporate Integrity Department initiatives and annual work plan.

Education/Experience requirements:

•         High School Diploma or equivalent required (Bachelor's degree preferred)
•         Minimum 1-3 years coding/billing for provider medical services required, 4-10 years' experience preferred
•         Certification from the American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC) or Certified Coding Specialist (CSS) required
•         Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) highly desirable
•         Exemplary written and oral communication skills; ability to navigate challenging conversations and provide effective provider education required
•         Strong computer skills including proficiency with Microsoft Office products including Word, Excel, PowerPoint and Outlook required
•         Additional software experience with EPIC, E&M University, 3M Encoder and other coding related tools desirable
•         Extensive knowledge and proficiency of CPT & ICD-10-CM guidelines required
•          Experience with professional fees auditing, monitoring, and analysis including provider utilization, statistical risk assessment and report development preferred
•         Experience with presenting and training of E&M guidelines and coding preferred
•         Self-directed and ability to work well both independently and with others