Physician Compliance Auditor II

Work Model & Salary 100% Remote The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience. About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job Summary The Physician Compliance Auditor II audits and evaluates compliance activities to ensure documentation meets standards. Establishes audit scope, uses tools, compiles data, reports findings, and provides recommendations and training. Audits may include documentation and coding accuracy for outpatient, inpatient, and emergency services using ICD-10, CPT, HCPCS, and other guidelines. Coding across multiple services lines E/M services Surgical procedures Diagnostic procedures Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine Work Model & Salary 100% Remote The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience. Essential Functions of the Role Performs chart audits and formulates recommendations based upon the audit findings and communicates them to the appropriate personnel. Implements coding reviews and creates work plans based on them. Ensures compliance issues and risks are identified and addressed. Develops curriculum for educating providers and staff on medical record documentation guidelines. Educates on diagnostic and procedural coding conventions and methodologies. Acts as a coding compliance and documentation resource and consultant for all providers, company administrators, and clinical staff. Assists in developing policies and procedures on coding compliance for clinics and the compliance department. Prepares and submits compliance reports to the compliance committee. Cross-trains other Physician Compliance Auditors in their area(s) of expertise to provide more depth and flexibility to the department. Key Success Factors Advanced knowledge of CPT, ICD-10, and HCPCS. CHC, AHFI, or CFE certification preferred. Maintains working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the compliance department. Ability to research complex topics regarding compliance and coding efficiently and accurately. Able to explain compliance concerns and resolutions clearly and concisely. Comfortable discussing them with all organization members. Proficient in Word, Excel, and PowerPoint. Four years auditing experience. Belonging Statement We believe that all people should feel welcomed, valued and supported. QUALIFICATIONS EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification EXPERIENCE - 4 Years of Experience Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM Coding experience across multiple service lines E/M services Surgical procedures Diagnostic procedures Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine CERTIFICATION/LICENSE/REGISTRATION Active coding certification: CPC (Verified through AAPC) or CCS-P (Verified through AHIMA) required Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Cert Prof Coder Physician (CPC-P): Must have one of the following: Cert Coding Spec Physician based (CCS-P), Cert Professional Coder (CPC), or Cert Prof Coder Physician (CPC-P).