Senior Medical Compliance Auditor – Audit & Compliance
MaineHealth Portland, ME
Full Time, Days
****THIS IS NOT A REMOTE POSITION
MaineHealth is seeking a Senior Medical Compliance Auditor in Portland. This position is responsible for review and analysis of Medical documentation to support acceptable billing and documentation practices at MaineHealth member hospitals. The Senior Medical Compliance Auditor prepares formal written reports of findings and appropriately disseminates information to the Department or Program Chief, Medical Record Services, Patient Accounts and respective leadership. The findings and analyses are used to evaluate compliance with various billing regulations. Technical and educational assistance is provided to various staff on improving documentation in relation to meeting compliance with billing regulations. Auditing and educational assistance are provided to various departments as necessary.
- Possess one of the following certifications: AHIMA-RHIT, CCS, CCS-P; AAPC-CPC, CPC-H, CPMA; HCCA-CHC and/or clinical experience as an RN or LPN.
- Five years’ experience with broad knowledge of medical terminology, anatomy and physiology, pathophysiology and disease process.
- In depth knowledge of hospital organizations and medical practices.
- Knowledge of physician billing practices, CMS billing regulations, CPT coding guidelines from the American Medical Association.
- Ability to establish and maintain effective working relationships with physicians, subordinates, administrators, supervisors, outside agency personnel, and all levels of hospital personnel in relation to appropriate documentation practices and compliance.
- Ability to direct the processing, collection, maintenance and analysis of compiled information and the preparation of reports from this data.
- Ability to maintain confidentiality in the performance of duties.
- Ability to analyze data and interpret it to others.
- Ability to maintain the stamina required to perform detailed and repetitive reviews and audits on a continuous basis.
- Ability to work independently and self-directed.
MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.