Lead Compliance Auditor

Lexington Medical Center

Job title: Lead Compliance Auditor

Company: Lexington Medical Center

Job description: Corporate Compliance

Full Time

Day Shift

8an – 4:30pm, Mon-Fri

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #2 in the state and #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina.

The 607-bed hospital anchors a health care network that includes five community medical centers and employs nearly 8,000 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices.

Job Summary

Analyze and audit LMC systems of the Physician Network and the hospital medical record data to determine if charges billed are supported by appropriate medical documentation. Monitors risk areas and conducts focused audits as identified in tandem with the Compliance Associate Director. Conducts quality assurance on other auditors as required. Prepares reports and meets with physicians, Advanced Practice Providers (APPs), and other compliance auditors to review audit results.

Minimum Qualifications

Minimum Education: Bachelor’s Degree in Business or Related Field

Minimum Years of Experience: 5 Years of Directly Related Experience

Substitutable Education & Experience (Optional): A Bachelor’s Degree and 5 years of experience can be substituted for the following combinations of education/work experience:

High School Diploma with 10 years of related experience;

Associate’s Degree with 7 years of related experience.

Required Certifications/Licensure: Certified Professional Coder (CPC) Certification through AAPC or Certified Coding Specialist (CCS) through AHIMA;

Certified Professional Medical Auditor (CPMA) Certification.

Required Training: Strong problem solving skills;

Ability to articulate orally and in writing an understanding of complex issues and detailed action plans, while representing the organization professionally. Must be able to communicate with physicians, Advanced Practice Providers (APPs), senior administrators and department staff;

Subject Matter Expert with extensive healthcare industry knowledge and experience in and around coding, billing, auditing, compliance and reimbursement for both facility and physician practices;

Extensive coding experience in multiple specialties;

Extensive knowledge of AMA, OIG, CMS, and other national coding and compliance guidelines;

Proficient in Microsoft Office.

Essential Functions

  • Responsible for conducting independent and complex audits of hospital and Physician Network records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare, Medicaid, and third party billing regulations and/or standards.
  • Independently completes assignments, manages risk-based audits and projects, and performs regulatory research and investigations.
  • Assists the Chief Compliance Officer in investigating inquires which may relate to erroneous billing and coding of services.
  • Works closely with other departments, Health Information Management and Revenue Integrity to conduct coding reviews and inquires.
  • Drafts formal written reports that summarize medical record findings for review.
  • Provides education on subjects pertinent to reviews conducted and any coding and billing changes to appropriate LMC staff.

Duties & Responsibilities

  • Determines whether medically necessary criteria are met as required by CMS and the fiscal intermediary through National Coverage Determinations (NDCs), Local Coverage Determinations (LCDs) and other guidance in effect at the time of the review.
  • Participates in risk assessment of areas of focus designated by the Recovery Audit Contractors, MIC, OIG, ZPIC and other regulatory agencies.
  • Consults with the Revenue Integrity personnel and the Compliance Associate Director when relevant issues of federal and state health care billing law and regulations are discovered to create overpayments.
  • Keeps abreast of ICD-10, CPT-4, and HCPCS coding changes, compliance issues and regulations and provides communication and updates regarding changes in regulations, policies or procedures pertaining to the Compliance Program.
  • Treats patients, fellow employees and all individuals met while representing the organization with courtesy and respect in keeping with the LMC vision.
  • Adheres to organization wide policies.
  • Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance – equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer

It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.

Expected salary:

Location: West Columbia, SC

Job date: Sat, 11 Mar 2023 08:47:48 GMT

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