Associate - Healthcare Compliance Auditor (Healthcare Transaction Strategy)

The Associate position is a junior staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents.  This position requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization.

The work of an Associate-level Healthcare Compliance Auditor primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government programs such as Medicare and Medicaid. Responsibilities include payer policy research, working with team to develop audit criteria,  data analysis, review of medical billing and supporting documentation, and development of client deliverables.

This specific position requires an interest in medical coding and compliance, and potential candidates must have or be willing to obtain a medical coding certification within 6 months of hire. 

Job Responsibilities:

• Support client engagements and discrete segments of larger projects;
• Research healthcare program requirements and payer guidelines;
• Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance;
• Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines;
• Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicate the audit findings and recommended areas for improvement to senior members of the team;
• Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas;
• Stay current on coding guidelines.
• Develop analyses using transactional data and/or financial data;
• Make valuable contributions to client deliverables;
• Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions;
• Participate in group practice meetings;
• Prioritize assignments and responsibilities to meet goals and deadlines.

Qualifications:

• An undergraduate degree in a major relevant to healthcare (Public Health, Healthcare Administration, etc.); 
• An active coding certification (may be in apprentice status) or willingness to obtain a coding certification from either AAPC or AHIMA within 6 months of hire;
• An interest in medical auditing;
• 0-2 years of work experience that demonstrates a strong interest in the healthcare industry; Internships, fellowships, or work experience in a hospital or healthcare system preferred. Candidates with more than 3 years of experience will not be considered for this role; 
• Preference will be given to candidates who possess some knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation; 
• Some knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements is preferred; 
• Proficient user in Microsoft Office Suite, specifically Excel, PowerPoint, Access, and Word.  A desire to expand those capabilities is required. 
• Strong attention to detail; 
• Excellent time management, organizational skills, and ability to prioritize work and meet deadlines; 
• Keen interest in healthcare compliance and healthcare policy; 
• Exceptional verbal and written communication skills; 
• Desire to work within a team environment.

Associate Salary Range: $70,000 – $100,000 per year.