Compliance Auditor (Medical Billing and Coding), Hybrid

• Must possess a Professional Certification such as Certified Professional Coder or equivalent.
• Proven experience in medical billing and coding
• Experience with auditing and monitoring clinical records and documentation

• Hours:

• Lunch: 1-hour paid lunch
• Workdays: In-office 3 days a week; work from home 2 days a week.
• Responsibilities include, but not limited to:

• Conduct anesthesia chart reviews under the Compliance Officer's guidance, focusing on completeness, quality, and billing accuracy, with an emphasis on correct coding. Communicate results to anesthesia practitioners and collaborate with internal departments on any relevant issues.
• Perform periodic reviews of the Coding department staff to identify billing and coding gaps, such as Time, Place of Service, Modifiers, CPT, and Diagnosis coding, addressing concerns and providing consultation as needed.
• Execute periodic probe audits to detect coding discrepancies that may lead to over- or under-billing. Document findings and educational efforts, providing feedback to stakeholders.
• Coordinate with external auditors or consultants for independent billing and coding audits or to clarify ambiguous items.
• Assist the Compliance Officer in addressing concerns from AMS staff via confidential channels.
• Help resolve overlapping time issues in billing software by researching documentation and seeking clarification from providers.
• Support the Compliance Officer with special requests, including Case Logs, guidance to the Clerical department, and requests from NSLIJ anesthesia service personnel.
• Stay updated on industry trends and changes to assess their relevance to the organization.
• Serve as a backup to the Compliance Officer in their absence, along with other assigned duties.

Northwell Health