Compliance Auditor in Greenwood Village, CO

More Information about this JobAsCompliance Auditoryou are responsible for protecting the business units’ assets by completing compliance audits; ensuring compliance with regulations and internal controls; recommending improvements in coding guidelines; educating the workforce on appropriate compliance standards; and guiding the work of external auditors.Essential Duties and Responsibilities:

Perform internal audits of the companies’ billing and coding to ensure compliance with coding rules and regulations

Monitor industry trends of audit risk areas and update the department workplan accordingly

Review and track compliance billing matters

Oversee third party auditors to ensure accuracy of audit findings

Assist in reviewing requests for information related to government and commercial insurance audits

Assist in reviewing and producing request for information related to government agency investigations

Formulate, affect, interpret, and implement compliance policies and procedures as needed

Assist in the development and provision of compliance billing and documentation training for employees and independent consultants

Coordinate, assist or conduct compliance investigations as required, which may include inspections of company policies and regulatory adherence, as well as inquiries into suspected or reported deviation from compliance program requirements

Maintain logs of inquiries and track research and disposition of compliance issues raised by senior management, employees, business partners, and external auditors

Identify trends in audit findings to mitigate potential risk areas

Provide education and compliance guidance to 3rd Party Billing agency, Revenue Cycle Management and Local Operations Management team as a result of audits or other inquiries

Monitor County/State EMS State Scope of Practice updates.

Track and prepare internal and external audit results for reporting to executive management

Perform other compliance audits as needed

Reviews external payor manuals to ensure clarifications and modification to program payment requirements are updated and communicated as appropriate

Adhere to all company policies and procedures

Adherence to and compliance with information systems security is everyone’s responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems

Ability to use / operate standard office equipment and tools

Education/Licensing/Certification:

Bachelor’s degree is preferred

Certification as CAC or willingness to become certified required

Experience:

Minimum of 3 years’ experience with auditing or QA of government healthcare claims

Knowledge and Skills:

Knowledge of ambulance coding preferred

Knowledge of RAT-STATS and general statistical sampling methodologies preferred

Previous clinical training as an EMT, Paramedic or nurse preferred

Knowledge of third-party reimbursement methods, including Medicare/Medicaid and general commercial health insurance practices preferred

Knowledge of HCPCs, and ICD-10 Guidelines preferred

Knowledge of the healthcare and compliance industry

Ability to perform detailed work accurately within agreed upon deadlines

Excellent interviewing and negotiating skills

Excellent computer skills, including proficiency in Excel, Access, Word, and PowerPoint

Ability to utilize critical thinking and work under general supervision

Effective oral, written, and interpersonal communication skills

EEO StatementGlobal Medical Response and its family of companies are an Equal Opportunity Employerincluding Veterans and DisabledRequisition ID2020-10673CategoryComplianceEmployment TypeRegular Full-Time