What are the responsibilities and job description for the Compliance Auditor position at Opelousas General Health System?
Responsible for conducting compliance audits identified though risk assessments and annual work plans, including processing a wide range of external audits and appeals with Medicare, Medicaid, and other third-party payors.
Essential Duties & Responsibilities:
- Handles RAC, TPE, SMRC, CERT and any other audits by CMS, and third-party payors.
- Appeals any findings from CMS audits and audits done by other payors.
- Educates respective departments about internal and external audit findings
- Reviews and appeals denied claims for lack of medical necessity, coding, billing and prior authorizations.
- Identifies trends in denials and assists respective departments in correcting these issues.
- Conducts internal audits as assigned by supervisor.
Education: Associate degree in Business Administration, Health Information Management or related healthcare field preferred. Certificate in Medical Coding preferred.
Certification: Certified Coding Specialist (CCS) required.
Additional experience required: 1 year in medical reviews, hospital claims and billing required.
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