Clinical Compliance Auditor

General Purpose

The Clinical Compliance Auditor is responsible for performing clinical compliance audits on facility medical records and billing information to ensure accuracy and compliance with regulations.

This role also involves participating in investigations and ethics response, as well as providing education, training, and enforcement, as requested.

The Clinical Audit Team will be comprised of therapists, nurses, medical records specialists and billing and coding specialists.

Essential Duties


* Conduct clinical compliance audits on facility medical records and billing information to ensure accuracy and adherence to regulatory coding and billing standards.


* Identify areas of non-compliance and recommend corrective actions.


* Participate in internal investigations and ethics hot line response, as requested, including reviewing complaints, conducting investigations, assigning follow-up actions, and confirming recommended remedial action occurs.


* Assist in the development and delivery of targeted educational materials and training programs to relevant Regional and facility staff on proper coding procedures and documentation requirements .


* Collaborate with the Regulatory Policy & Standards team to stay updated on state and federal regulations, coding guidelines and payor guidance.


* Contribute to the Compliance Newsletter and Communications to keep staff informed about compliance updates and best practices.


* Assist in Triple Check development, training and enhancements to improve compliance and accuracy in billing and coding practices.

Qualifications


* Masters or Doctorate in Speech-Language Pathology; Licensed Physical Therapist; Registered Nurse or Licensed Practical Nurse; or Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).


* Minimum of 3 years of experience in clinical billing and coding compliance auditing.


* Medical Records background and solid understanding of ICD-10 coding guidelines is preferred.


* Strong knowledge of state and federal regulations related to healthcare billing and coding.


* Excellent analytical and problem-solving skills.


* Strong communication and interpersonal skills.


* Ability to work independently and as part of a team.


* Detail-oriented with a high level of accuracy.

Join PACS: Elevate Healthcare with Us!

PACS is elevating healthcare by revolutionizing our approach to leadership and quality care.

Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment, we strive to foster a culture of compassionate care within our teams and the communities we serve.

As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.

If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS.

Together, let's shape the future of healthcare!

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