Are you passionate about helping kids be their best selves?

UPMC Children’s Community Pediatrics is hiring a Full-Time Compliance Auditor, Intermediate to support the office Remotely.

Must live in the state of PA.

Responsibilities:

Conduct UPMC wide auditing and monitoring to ensure coding/documentation combinations and medical record documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards. Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCD and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting. Conduct audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy. Develop concise and well referenced audit workpapers. Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations. Conduct post-audit compliance training sessions for physicians and non-physician practitioners as audit results dictate. These training sessions will include, but are not limited to, provision of education specific to the issues found on audit and will be largely based on the documentation, coding and billing rules as set forth by CMS and other relevant Federal and State regulatory agencies. Maintain current knowledge and understanding of regulatory trends and changes in coding policy and reimbursement methods.