We are seeking a Compliance Auditor who will provide audit and research support to physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Works in close collaboration with the Sr. Auditors/Trainers, Associate Managers, Associate Director and Director to provide input and assist in the development of any applicable training and education content. Assists in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. The documentation audits are conducted as part of the School of Medicine's Professional Fee Compliance Program.
Specific Duties & Responsibilities
Essential Job Functions of Compliance Auditor
Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians or by billing office coders.
Research and answers billing and documentation questions or problems submitted by faculty, advanced practice professionals, departments, billing staff, and others to ensure compliance with specific payer regulations and Johns Hopkins Medicine policies and procedures.
Verifies and corrects as necessary, the audit work completed by other Auditors.
Reviews documentation or coding patterns by a clinician, division or department that poses a compliance risk and provides input on recommended solutions.
Assists with the development of training sessions for billing clinicians, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
Participates in clinician feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation and coding reviews and provides input and support as needed.
Supports the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs.
Assists in the research and development of medical record documentation standards and requirements related to clinical services billing.
Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and professional fee billing.
Performs other compliance related activities as necessary.
Compliance Auditors may be asked to assist with training new staff or correcting the work of others.
Identifies and suggests process and operational improvements.
Knows the formal and informal departmental goals, standards, policies, and procedures which include familiarity of other departments within the school/division. Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.
On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area.
Routinely handles confidential patient information and sensitive financial information.
Knowledge, Skills & Abilities
Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
Must be able to learn quickly and work independently to address a variety of complex issues.
Must be flexible to adjust to the development and refinement of new processes and procedures. CPT and ICD-10 coding required, including coding from clinical documentation, or auditing the coding of others.
Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required.
Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred. Demonstrated communication, analytical and organizational skills are essential.
Demonstrated training or teaching experience preferred but not required.
Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.
Experience with Epic, and other clinical information systems preferred. Must be self-motivated and comfortable working independently, as a team member.
Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.
Sitting in a normal seated position for extended periods of time.
Reaching by extending hand(s) or arm(s) in any direction.
Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.
Communication skills, using the spoken word.
Ability to see within normal parameters, ability to hear within normal range and ability to move about.
*This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
Bachelor's Degree in health care-related or business-related field. A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.
Two years of auditing/billing compliance required.
Recent, direct experience with third party payer requirements for physicians may substitute for some education. A master's degree in a health care related discipline may be substituted for up to one year of experience.
Additional coding certifications.
Minimum of five years related experience.
Demonstrated training or teaching experience.
Classified Title: Billing Compliance Auditor Role/Level/Range: ATP/04/PD Starting Salary Range: Min $62,300 - Max $109,000 Annually ($79,047 targeted; Commensurate with experience) Employee group: Full Time Schedule: M-F 8:30-5PM Exempt Status: Exempt Location: Hybrid Department name: SOM Admin CPA Billing Quality Assurance Personnel area: School of Medicine
Total Rewards The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines: JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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