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