- Sayre, Pennsylvania, United States
- On-site
- Full-time · Senior
- 1–5 years
A senior level Compliance Examiner and Analyst who works with the Compliance Officers to examine and analyze fraud, waste and abuse, compliance, and privacy related activities.
Responsibilities
- Examine and analyze fraud, waste and abuse, compliance, and privacy related activities
- Assess compliance with CPT, ICD-9/10, HCPCS, Payor guidelines, CMS guidelines, state and federal guidelines, cash controls, and TGC policies
- Analyze internal and external risks and develop a Work Plan to detect, audit, analyze and report findings to Compliance officers and leadership partners
- Develop and provide guidance to improvement teams related to improving conditions that may have caused errors
- Conduct concurrent, prospective, and retrospective audits of medical record documentation, billing activity, provider activity, service lines, department processes, financials, contracts, assets, licensure/certification, etc.
Requirements
- CPC (Certified Professional coder) required
- LPN or CPMA preferred
- Certifications from AHIMA (RHIA, RHIT, or CCS) or AAPC considered
- Bachelor's degree preferred
- Nice to have: Certified Fraud Examiner