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Job Title Compliance Auditor
Location ProTransport-1
Department Administration
FLSA Status Non-Exempt


Job Summary:

Under the supervision of the Compliance Audit Manager, the Compliance Auditor completes audits related to coding, billing, documentation and reimbursement activities including both formal and informal audits.  This role is responsible for 1) auditing according to the Center of Medicare and Medicaid Services (CMS) guidelines, 2) ensuring compliance with established standards of practice, applicable state and federal laws and regulations, 3) advising leadership on performance measurements, risks assessments and special initiatives related to billing compliance.

Essential Duties and Responsibilities:

  • Works with compliance audit manager to ensure that claims are being billed and administered in accordance with health insurance requirements
  • Identifies persistent claim error trends and reports those trends immediately to management
  • Creates audit reports with detailed findings
  • Participates in the development, review, implementation and ongoing monitoring of compliance activities
  • Promotes compliance within all facets of job responsibilities
  • Audits both government and non-government billing
  • Makes recommendations on how to improve compliance controls, conducts analysis and creates reports to help improve business compliance
  • Assists with deliverables for various internal and external audits
  • Coordinates level of service management reviews
  • Responds to ADRs, CERTS and various payer requests as assigned
  • Participates in educational webinars and web-based training related to ambulance billing
  • Utilizes resources such as CMS publications relating to ambulance billing
  • Logs and tracks internal and external audit activity
  • Other duties as assigned

Minimum Qualifications:

  • High school diploma
  • Minimum of three years auditing and billing experience
  • Knowledge of CMS guidelines
  • Proficient in Microsoft Office Suite
  • Understanding of Medicare fee schedules, appropriate payments, and contracted rates
  • Comprehensive understanding of ICD10 codes, condition coding, and HCPCs codes
  • Knowledge of regulations related to medical billing for both government and non-government payors
  • Must have knowledge of medical terminology
  • Ability to analyze, evaluate, reach conclusions, and make appropriate recommendations
  • Ability to communicate to all levels of management
  • Exceptional attention to detail
  • Certified Ambulance Coding (CAC) preferred

Physical Requirements:

  • Typical Working Conditions: office environment where temperatures are comfortable and noise level is low to moderate
  • Heavy Computer usage requiring frequent repetitive hand movements
  • Ability to sit for extended period
  • Must be able to hear and communicate clearly to perform job duties in person and over the telephone
  • Adequate vision required to be able to read information from printed sources and computer screens

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