Sr. Compliance Auditor

We are seeking a Sr. Compliance Auditor who will provide on-going training and support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the clinical departments, Physicians Billing Service, and the Johns Hopkins Health System Compliance Office. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program. Prepares reports for the Sr. Director, Director, and clinical departments regarding the status or results of the reviews. Summary results are presented to the Clinical Practice Association’s Board of Governors, the University’s Trustee Committee for Audits and Insurance and other appropriate offices within the School of Medicine or Johns Hopkins Medicine.

Specific Duties & Responsibilities

• Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
• Verifies and corrects as necessary, the audit work completed by the Billing Compliance Auditors or other Sr. Auditors/Trainers.
• Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
• Assists departments and providers in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities.
• Conducts training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
• Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed.
• Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.
• Regularly monitors potential billing problems and/or billing errors identified by each departments’ professional fee billing office.
• Prepares and revises as needed a Compliance Training Manual for routine and special training programs.
• Assists in the development of medical record documentation standards and requirements related to clinical services billing.
• Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.
• Performs other compliance related activities as necessary.

Scope of Responsibility

• Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division.
• Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

Decision Making

• On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
• Routinely handles confidential patient information and sensitive financial information.

Authority

• Sr. Billing Compliance Auditor/Trainer may be asked to assist with training new staff or correcting the work of others.
• Identifies and suggests process and operational improvements.

Communications

• Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

Additional Knowledge, Skills & Abilities

• Recent experience with Medicare regulations required.
• Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge required.
• Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
• Must be able to learn quickly and work independently to address a variety of complex issues.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.
• Extensive knowledge of Medicare regulations regarding teaching phys