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BRG · 8 hours ago

Healthcare Compliance Auditor (Healthcare Transaction & Strategy)

United States

Full-time

Remote

Mid, Senior Level

$70K/yr - $150K/yr

2+ years exp

BRG is a consulting firm that combines academic credentials with business expertise. They are seeking a Healthcare Compliance Auditor to perform regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, focusing on government programs such as Medicare and Medicaid.

AdviceConsultingFinanceFinancial ServicesManagement Consulting

No H1B

Responsibilities

Plan and perform medical record audits to determine coding accuracy and compliant claims submission

Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance

Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines

Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement

Serve as a subject matter expert on interpretation and application of coding and documentation guidelines

Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas

Stay current on coding guidelines

Develop analyses using transactional data and/or financial data

Generate client deliverables and make valuable contributions to expert reports

Manage client relationships and communicate results and work product as appropriate

Manage junior staff and delegate assignments as directed by more senior managers

Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions

Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting

Prioritize assignments and responsibilities to meet goals and deadlines

Qualification

Medical coding certificationHealthcare compliance expertiseCPT-4/HCPCS/ICD-10-CM knowledgeHealthcare provider billingData analysis skillsMicrosoft Office proficiencyTime managementOrganizational skillsVerbal communicationWritten communicationTeam collaboration

Required

An undergraduate degree (e.g., BS, BA)

Active coding certification from either AAPC or AHIMA is required

2+ years of work experience with a focus on healthcare provider billing and coding; 5-7 years of experience is required for the Managing Consultant level position

Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation

Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements

Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results

Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word

Commitment to producing high quality analysis and attention to detail

Excellent time management, organizational skills, and ability to prioritize work and meet deadlines

Keen interest in healthcare compliance and healthcare policy

Exceptional verbal and written communication skills

Desire to work within a team environment

Candidate must be able to submit verification of their legal right to work in the U.S., without company sponsorship

Preferred

Preference will be given to candidates that are certified in medical auditing

Preference will be given to candidates that are experienced with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs)

Company

BRG

Glassdoor3.7

BRG combines world-leading academic credentials with world-tested business expertise, purpose-built for agility and connectivity, which sets us apart—and gets our clients ahead.

Founded in 2010

Emeryville, California, USA

1001-5000 employees