Compliance Auditor / Analyst - Medical Coder
- Summary
The purpose of this Term-Limited Temporary (TLT) position is to manage Compliance Office audit functions for Public Health -Seattle and King County. Following the established protocols, the Compliance Auditor will design, perform, and lead complex audit projects of various aspects of the healthcare delivery system, to include but not limited to, clinical documentation, coding, billing and reimbursement.
The Compliance Auditor is a key position within Public Health's Compliance, HIT, Epic Support Section (CHESS), ensuring Public Health is in compliance with all internal and external policies and regulations related to healthcare compliance, including but not limited to patient privacy, record documentation and billing and coding. This position will also serve as an expert advisor to management on compliance audit issues.
This position works with peers and team members to support and build on the Department’s efforts related to Equity and Social Justice and Racism as a Public Health Crisis.
Under the supervision of the Compliance Manager/ Privacy Officer (or designee), the Compliance Auditor/ Analyst is an independent self-directed individual who identifies opportunities for improving compliance with internal policies and procedures and federal, state and local regulations.
The Compliance Auditor/ Analyst will work under general supervision, requiring minimal instruction and guidance to perform duties and must demonstrate initiative and use independent judgment in conducting their work. The results of these activities are communicated to leadership as findings, conclusions, and recommendations; potential areas of concern; opportunity, and/or risk; and degree of compliance with established policies or regulatory requirements. This position is responsible for job duties in accordance with shared purpose, vision and values of Public Health – Seattle & King County.*THIS POSTING WILL REMAIN POSTED COUNTINOUSLY, WILL REVIEW APPLICANTS ON 12/14/2022*- Job Duties
- Develop audit process and audit the Compliance Office work plan, including ongoing monitoring of department health care compliance to applicable federal and state regulations as well as King County and Public Health policies and procedures.
- Design, perform, and lead complex audit projects of various aspects of the health care delivery system, to include but not limited to, clinical documentation, coding, billing and reimbursement, physician relationships, etc.
- Develop and create compliance monitoring and auditing tools including establishment of automated processes to organize complex data.
- Design compliance audit programs and perform the various audit tests of compliance controls of both the design and operating effectiveness by obtaining and analyzing audit evidence, preparing audit workpapers, evaluating test results, and drawing conclusions and writing formal audit reports on the adequacy and effectiveness of compliance or regulatory criteria.
- Provide feedback and make recommendations to department and division leadership as well as training and education to staff as appropriate based on audit findings and best practices. Collaboratively establish corrective action plans.
- Serve as the subject matter expert in reviewing billing denials and providers’ coding queries.
- Perform subsequent audits to ensure appropriate corrective action taken.
- Assist with or lead compliance related investigations, allegations of fraud, waste and abuse and other violations as may be needed.
- Assist in risk assessments and incorporate results in development of an audit work plan.
- Maintain a current working knowledge of HIPAA and related rules, regulations, resources, trends, developments and department related policies.
- Develop and maintain professional skills and knowledge through attendance at relevant conferences, seminars and other educational programs, participation in professional organizations and review of current literature.
- Maintain necessary documentation of audits and relevant materials.
- Participate in external audits and reviews by regulatory agencies and ensure implementation of corrective action occurs
- Experience, Qualifications, Knowledge, Skills
- Knowledge of compliance audit procedures and principles in a health care setting. Particular knowledge in a Public Health care setting is desired.
- Knowledge of coding and billing and auditing and extensive knowledge of ICD-10-PCS, ICD-10-CM, CPT and HCPCS coding principles and guidelines.
- Extensive knowledge in outpatient setting Office of Evaluation and Management (E/M) services guidelines and regulations.
- Required Certifications includes one or more of the following:
- a) American Academy of Professional Coders (AAPC) Certifications: Certified Professional Coder (CPC), Certified Outpatient Coding (COC), and/or Certified Professional Medical Auditor (CPMA).
- b) American Health Information Management Association (AHIMA) Certification: Certified Coding Specialist (CCS).
- Problem solving skills and the ability to facilitate the problem-solving process by identifying and communicating key issues and offering creative, new, and effective solutions.
- Customer service and consultation skills demonstrated by the ability to be collaborative, flexible, and open to input from others.
- Ability to develop and maintain good working relationships by being approachable and utilize good interpersonal skills; ability to work in a team setting.
- Ability to figure out and create effective ways to get work done. Ability to set priorities and focus on the important tasks that need to be done.
- Demonstrated skills planning and managing projects including setting objectives and goals, measuring performance, and evaluating results. Demonstrated skill meeting and exceeding goals.
DESIRED QUALIFICATIONS:- Bachelor’s degree in a Health Sciences discipline, Business administration, OR related field AND at least five years of auditing experience with healthcare billing and coding operations or compliance.
- Supplemental Information
Forbes recently named King County as one of Washington State's best employers.
Together, with leadership and our employees, we're changing the way government delivers service and winning national recognition as a model of excellence. Are you ready to make a difference? Come join the team dedicated to serving one of the nation's best places to live, work and play.
Guided by our "True North", we are making King County a welcoming community where every person can thrive. We value diversity, inclusion and belonging in our workplace and workforce. To reach this goal we are committed to workforce equity. Equitable recruiting, support, and retention is how we will obtain the highest quality workforce in our region; a workforce that shares and will help advance our guiding principles--we are one team; we solve problems; we focus on the customer; we drive for results; we are racially just; we respect all people; we lead the way; and we are responsible stewards. We encourage people of all backgrounds and identities to apply, including Native American and people of color, immigrants, refugees, women, LGBTQ+, people living with disabilities, and veterans.
COVID-19 Vaccination Requirement
King County Executive Branch employees are required to be fully vaccinated against COVID-19. If you are the successful candidate for the position you applied for, the County will send you a conditional offer letter.
As a condition of employment, prior to a final offer of employment, you will be required to:- submit proof of vaccination, or
- have an approved request for medical or religious exemption and an approved accommodation. Philosophical, political, scientific, or sociological objections to vaccination will not be considered for an exemption or accommodation.
People are considered fully vaccinated against COVID-19 two weeks after receiving the final dose of a vaccination approved by the Center for Disease Control and Prevention (CDC).
The Executive Branch includes employees in the Executive branch, the Assessor's Office, Elections, the King County Sheriff's Office, and the Executive Office.
King County is an Equal Employment Opportunity (EEO) Employer
No person is unlawfully excluded from employment opportunities based on race, color, religion, national origin, sex (including gender identity, sexual orientation and pregnancy), age, genetic information, disability, veteran status, or other protected class. Our EEO policy applies to all employment actions, including but not limited to recruitment, hiring, selection for training, promotion, transfer, demotion, layoff, termination, rates of pay or other forms of compensation.
To Apply
If you are interested in pursuing this position, please follow the application instructions carefully. If you need this announcement in an alternate language or format, would like to request accommodation or assistance in the application or assessment process or if you have questions, please contact the recruiter listed on this job announcement.
Who May Apply
This position is open to all qualified candidates.
Application Process:
The following items are required to be considered for this vacancy:- An electronic application through www.kingcounty.gov/jobs or www.governmentjobs.com (use the "Apply" link) including work history and position duties.
- Candidates must submit a resume
- Responses to ALL supplemental questions.
- The selection process may include but is not limited to evaluation of application materials and supplemental questions, interviewing, and testing. For more information on our selection process, please refer to www.kingcounty.gov/depts/health/jobs/hiring.
- Regular and reliable attendance, effective communication skills, and development of effective working relationships are requirements of all Public Health positions.
- Staff may be required to play an active role in the event of a public health emergency, which may include changes in responsibilities, work location, and working hours.
Telecommuting and occasional work at the Chinook Building, 401 Fifth Avenue. Seattle, WA 98104.
Employees will be provided with a County issued laptop and must maintain a workspace with an internet connection where they can reliably perform work and remain available and responsive during scheduled work hours. Employees must reside in WA state and within a reasonable distance to their King County worksite to respond to workplace reporting requirements. There will be situations where the employee is required to report to a County worksite. Please note that when an employee conducts work that is likely to bring them in contact with another individual, safety precautions are required by the department in alignment with the Public Health Directive from the Seattle & King County Public Health Officer.
To support employees during this time King County has a robust collection of tools and resources to support working remotely. The individual selected for this opportunity will be joining an innovative and progressive team. King County is doing its part to reduce the spread of COVID-19 and remains committed to reducing our carbon footprint.
Work Schedule:
Monday - Friday; 40 hours/week
Necessary Special Requirements
- The selected candidate will be required to submit to a thorough background investigation.
- Employees are required to protect the privacy and security of protected health information as defined in State and Federal Law.
- Employees are required to adhere to OSHA/WISHA guidelines including but not limited to completing required training on time.
Contact:
If you need this announcement in an alternate language or format, would like to request accommodation or assistance in the application or assessment process or if you have questions please contact please contact: Alexis Owens, Human Resource Analyst, at Alowens@kingcounty.gov.
King County offers a highly-competitive compensation and benefits package designed to meet the diverse needs of our employees and support our employees' health and well-being. Eligible positions receive the following benefits and have access to the following programs:
- Medical, dental, and vision coverage: King County pays 100% of the premiums for eligible employees and family members
- Life and disability insurance: employees are provided basic coverage and given the opportunity to purchase additional insurance for both the employee and eligible dependents
- Retirement: King County employees are eligible to participate in a pension plan through the Washington State Department of Retirement Systems and a 457(b) deferred-compensation plan
- Transportation program and ORCA transit pass
- 10 paid holidays each year (plus 2 personal holidays)
- Generous vacation and paid sick leave
- Paid parental leave, family and medical leaves, and volunteer leave
- Flexible Spending Account
- Wellness programs
- Onsite gyms and activity centers
- Employee giving program
- Employee assistance programs
- Flexible schedules and telecommuting options, depending on position
- Training and career development programs
This is a general description of the benefits offered to eligible King County employees, and every effort has been made to ensure its accuracy. If any information on this document conflicts with the provisions of a collective bargaining agreement (CBA), the CBA prevails. Also, in the event of any incorrect information in this document, applicable laws, policies, rules, CBAs, or official plan documents will prevail.
NOTE: Benefits for Term Limited Temporary (TLT) or Short Term Temporary (STT) positions, including leave eligibility and/or participation in the pension plan through the Washington State Department of Retirement Systems, will vary based upon the terms and details of the position. Short Term Temporary positions are not eligible for an ORCA transit pass.
For inquiries about the specifics of this position, please contact the recruiter identified on this job posting.
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01Have you successfully developed and planned ICD-10-CM diagnosis, CPT procedural and Evaluation and management (E/M) services coding audits for compliance with healthcare regulations?
- Yes
- No
02If you answered yes to question #1, please describe in detail your experience in successfully developing and planning coding audits for compliance with healthcare regulations. If you answered no to question #1, please respond N/A.03Please indicate the number of years of experience you have successfully developed and planned coding audits for compliance with healthcare regulations.- Less than 1 year
- 1 to 3 years
- 3 to 5 years
- More than 5 years
04Have you successfully prepared reports, provided recommendations and developed and monitored corrective action plans based on findings from provider coding audits in a healthcare setting?- Yes
- No
05If you answered yes to question #4, please describe in detail how you have successfully provided recommendations and developed and monitored corrective action plans based on findings from provider coding audits in a healthcare setting. If you answered no to question #4, please respond N/A.06Please indicate if you have any of the following coding and/or auditing certifications:- Certified Professional Coder (CPC)
- Certified Outpatient Coder (COC)
- Certified Coding Specialist (CCS)
- Certified Professional Medical Auditor (CPMA)
07Are you applying to this position as an eligible current or previous King County Employee Priority Placement Program Participant? Is this position the same or lower percentage of full-time when compared to the position held at the point of the notification of layoff? Do you possess the skills and abilities to qualify for this position?- Yes, I was given a layoff notice from my role at King County and I am within two years of the effective date of my layoff. Additionally, the position I was laid off from was the same or a higher percentage of FT status when compared to this one.
- No.
08If you answered yes to the question above and you are applying for this position as a Priority Placement Participant, to be considered, you must provide the following three pieces of information in the space provided: 1. The title you held when you received your layoff notice 2. The department you worked in 3. The effective date of your layoffRequired Question