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Compliance Auditor, Intermediate (CEMC, CPC, or CPMA)
Compliance Auditor, Intermediate (CEMC, CPC, or CPMA)UPMC - Pittsburgh Medical Center • Pittsburgh, PA, US
Compliance Auditor, Intermediate (CEMC, CPC, or CPMA)

Compliance Auditor, Intermediate (CEMC, CPC, or CPMA)

UPMC - Pittsburgh Medical Center • Pittsburgh, PA, US
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Job Description

Join UPMC Corporate Compliance as an Intermediate Compliance Auditor!

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Are you passionate about ensuring accuracy and compliance in healthcare documentation and billing? Do you thrive in a dynamic environment where your expertise can make a significant impact? UPMC Corporate Compliance is seeking a dedicated and detail-oriented Intermediate Compliance Auditor to join our team! This position will be based out of Forbes Tower in Pittsburgh, PA . This is an onsite position with the potential to work from home.

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Key Responsibilities :

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  • Comprehensive Auditing :  Conduct UPMC-wide audits to ensure medical record documentation supports the services coded and billed in accordance with state and federal regulations.

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  • Code Validation :  Validate ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting.

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  • Regulatory Compliance :  Conduct audits on various compliance topics to evaluate adherence to state and federal laws, regulations, and policies.

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  • Reporting :  Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.

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  • Stakeholder Communication :  Communicate audit findings and corrective actions to key stakeholders.

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  • Leadership Advising :  Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations.

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  • Knowledge Maintenance :  Stay current with regulatory trends and changes in coding policy and reimbursement methods.

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    Why UPMC?

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    At UPMC, we are committed to fostering a culture of compliance and excellence. As an Intermediate Compliance Auditor, you will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations. Join us and be part of a team that values your expertise and dedication to making a difference in healthcare compliance.

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    Apply today and take the next step in your career with UPMC Corporate Compliance!

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  • High School Diploma or equivalent required.

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  • Associate's degree or comparable technical school diploma is preferred.

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  • 3 or more years of experience in medical coding, billing, auditing and compliance.

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  • Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).

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  • Knowledge of coding / classification systems appropriate for inpatient / outpatient, DRG prospective payment system or office setting E / M codes.

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  • Experience in an academic medical center setting is strongly preferred.

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  • Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.

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  • Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.

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  • Must have strong interpersonal, organizational, analytical and communication skills.

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  • Ability to work in a fast-paced environment.

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  • Must have ability to manage multiple tasks and projects and forge strong interpersonal relationships within the department and with other departments.

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  • Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential.

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  • Experience researching and interpreting regulation and performing internal investigations is essential.

    • Licensure, Certifications, and Clearances :

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    One of the following is required :

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  • Certified Coding Specialist (CCS)

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  • Certified Inpatient Coder (CIC)

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  • Certified Evaluation & Management Coder (CEMC)

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  • Certified Professional Medical Auditor (CPMA)

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  • Certified Professional Coder (CPC)

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  • Certified Medical Coder (CMC)

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  • OR Registered Health Information Administrator (RHIA)

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  • Registered Health Information Technician (RHIT)

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  • OR Licensed Professional Nurse (LPN)

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  • Registered Nurse (RN)

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    Required : \n \n

  • Act 34

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    UPMC is an Equal Opportunity Employer / Disability / Veteran

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    Compliance Auditor • Pittsburgh, PA, US

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