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Internal Auditor, Compliance/Medical Coding - ONET Job Title: (Auditors)
Industry: Freestanding Ambulatory Surgical and Emergency Centers share on twitter share on Facebook
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Job Title:   Internal Auditor, Compliance/Medical Coding
ONET Job Title:   Auditors
Industry:   Freestanding Ambulatory Surgical and Emergency Centers
Job Type:   Permanent
Job Shift:   First Shift (Day)
Job Location:   St. Thomas
Minimum Education:   Bachelors Degree
Career Level:   Experienced (Non-Manager)
Minimum Experience:   5 Years
Work Permit:   Virgin Islands (US)
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Job Description:

Job Summary:
The Internal Auditor, Compliance / Medical Coding is primarily responsible for conducting audits of medical records and billing statements to verify patient charges, ensure proper documentation and identify compliance issues; develop detailed audit plans and programs with regard to policy and procedures based on knowledge of applicable laws, rules, best practices and regulations; ensure the existence, completeness and proper functioning of internal control systems and the reliability and accuracy of financial data. The Internal Auditor will audit adherence to the organization’s policies and procedures regarding the retention and destruction of corporate records both electronic and hard copy. The Internal Auditor must possess adequate knowledge of legal documents and Medicare billing requirements and the ability to interact with hospital insurance representatives to justify charges and minimize losses.  
Scope and Complexity:
The mission of the Internal Auditor, Compliance/Medical Coding is to ensure the existence, completeness and proper functioning of internal control systems which safeguard assets, ensure the reliability and accuracy of billing data, promote operational efficiency, assure compliance with policies and adhere to brand standards.  Overall responsibilities include reviewing a healthcare client’s patient medical charts and records for compliance with federal coding regulations and guidelines. The Internal Auditor will evaluate internal operations to validate that everything provided to the patient has been documented. Additionally the Internal Auditor will provide a review of codes assigned to medical diagnoses and clinical procedures to ensure that medical billing conforms to legal and procedural requirements and review develop and/or modify policies, systems and protocols to achieve and maintain compatibility with Medicare billing requirements and compliance standards. This position requires a great degree of flexibility working independently and with members of the ICMC Internal Audit Team. The Internal Auditor, Compliance/Medical Coding must be able to effectively communicate with individuals familiar with auditing and federal regulations to promote networking, learning and a collaborative approach to problem resolution. 
Responsibilities:  
  • Ensure compliance through audit and research
  • Verify patient charges and documentation of medical records
  • Develop and implement detailed audit plans and programs to ensure federal compliance
  • Evaluate the adequacy, efficiency and effectiveness of billing internal controls
  • Review internal policies and procedures for compliance issues
  • Conduct audits of both medical and corporate records along with billing statements to identify compliance issues
  • Prepare detailed reports specific to audit procedures and document the audit procedures performed
  • Provide assistance to external auditors and the internal audit team as requested
  • Provide updates to the audit and compliance committees as requested
  • Meet with hospital insurance representatives to justify charges and minimize losses as needed        
  • Must live or be willing to relocate to St. Thomas, US Virgin Islands


Skills Required

Skills & Experience:

  • Bachelors Degree (BS/BA) in a closely related field
  •  3+ years billing practice audits
  •  5+ years conducting audits of facility and physician medical and billing records
  • RHIT, CCS and/or CCS-P preferred
  • RN with medical billing experience strongly preferred
  • Knowledge of applicable laws, rules, best practices and regulations
  • Knowledge of applicable legal documents and Medicare billing requirements
  • Ability to communicate effectively in both written and oral formats
  •  Advanced Microsoft Office
  • Experience with Electronic Medical Records (EMR), specifically the Eclypsis System
  • Clinical experience in a hospital or physician's office preferred

Core Competencies:
  • Knowledge:
    • Risk analysis and management;
    • Internal audit industry perspective
  • Flexibility:
    • Adaptive to change:  ability to quickly and effectively adjust behavior or schedule
to meet changing business requirements;
  • Organization:
    • Ability to manage multiple projects within tight timeframe;
    • Administrative capability and efficiency;
    • Problem-solving, prioritizing;
    • Strong analytical and organizational skills;
  • Interpersonal skills:
    • Build relationships with peers and stakeholders;
    • Ability to work collaboratively;
    • Strong work ethic;
  • Communication:
    • Verbal and written business communication (technical and informational);;
    • Mediation (conflict resolution);
    • Strong ability to facilitate meetings;
 


Company Information More jobs from this company 
Company Name: International Capital & Management Company
Company Description:
International Capital & Management Company (ICMC) provides a variety of management services to clients throughout the USA and globally. ICMC specializes in banking, finance, investment, corporate travel management and Lean Six Sigma organizational improvement - supporting managed growth of our client's businesses.  ICMC is a US Virgin Islands company.
        
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