[Hiring] Compliance Billing & Coding Auditor II @Stanford Health Care

Role Description

Billing and Coding Compliance Auditors conduct audits and monitoring activities to identify and address compliance risks related to billing and coding practices. They review and evaluate healthcare regulatory compliance, focusing on the detection of documentation, coding, and billing errors.

• Assess the adequacy and accuracy of documentation supporting billed services, including ICD, CPT, HCPCS, and other third-party payer codes.
• Ensure adherence to Teaching Physician guidelines, Evaluation & Management criteria, DRG and APC assignments, medical necessity, and reimbursement accuracy.
• Serve as a communication channel, partnering with Billing and Coding Compliance Educators to address compliance issues.
• Conduct thorough investigations into billing and coding compliance matters, ensuring adherence to regulatory standards and identifying discrepancies.
• Analyze data, collaborate with relevant departments, and implement corrective actions to enhance compliance and mitigate risks.

Qualifications

• Associate’s degree in a work-related discipline/field from an accredited college or university (or equivalent combination of education/experience) required.
• Minimum four (4) years of progressively responsible directly related work experience required.
• EPIC EHR experience preferred.

Requirements

• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
• Ability to communicate effectively in written and verbal formats including summarizing data and presenting results.
• Ability to provide leadership in problem identification and issue resolution.
• Ability to change the course of events through convincing arguments supported by data.
• Ability to apply Critical Thinking skills to issues and situations.
• Ability to mediate and solve complex work problems and issues.
• Ability to effectively facilitate work groups to successful outcomes.
• Knowledge of coding conventions including ICD-10-CM/PCS, HCPCS, E&M, and CPT.
• Knowledge of DRG/APC reimbursement.
• Knowledge of third-party payer rules and regulations.
• Knowledge of healthcare compliance audit requirements, principles, and techniques.
• Ability to plan, organize and conduct detailed healthcare corporate compliance functions and audits.
• Ability to model and demonstrate consistently high standards of professional ethics, integrity, and trust.
• Ability to maintain confidentiality of sensitive information.
• Knowledge of computer systems, specifically EPIC and 3M.
• Knowledge of computer software including Microsoft Word, Excel, and PowerPoint.

Benefits

• Base Pay Scale: Generally starting at $52.69 - $69.82 per hour.
• The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty, and training.

Company Description

Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment.

• SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability.
• People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply.
• Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.