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Join UPMC Corporate Compliance as an Intermediate Compliance Auditor!

Are you passionate about ensuring accuracy and compliance in healthcare documentation and billing? Do you thrive in a dynamic environment where your expertise can make a significant impact? **UPMC Corporate Compliance** is seeking a dedicated and detail-oriented **Intermediate Compliance Auditor** to join our team! This position will be based out of **Forbes Tower in Pittsburgh, PA** . This is an onsite position with the potential to work from home.

Key Responsibilities:

• **Comprehensive Auditing:** Conduct UPMC-wide audits to ensure medical record documentation supports the services coded and billed in accordance with state and federal regulations.

• **Code Validation:** Validate ICD-10-CM, CPT, and HCPCS codes to ensure consistency and efficiency in claims processing, data collection, and quality reporting.

• **Regulatory Compliance:** Conduct audits on various compliance topics to evaluate adherence to state and federal laws, regulations, and policies.

• **Reporting:** Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.

• **Stakeholder Communication:** Communicate audit findings and corrective actions to key stakeholders.

• **Leadership Advising:** Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations.

• **Knowledge Maintenance:** Stay current with regulatory trends and changes in coding policy and reimbursement methods.

Why UPMC?

At UPMC, we are committed to fostering a culture of compliance and excellence. As an Intermediate Compliance Auditor, you will play a crucial role in upholding our standards and ensuring the highest level of integrity in our operations. Join us and be part of a team that values your expertise and dedication to making a difference in healthcare compliance.

Apply today and take the next step in your career with UPMC Corporate Compliance!

+ High School Diploma or equivalent required.

+ Associate's degree or comparable technical school diploma is preferred.

+ 3 or more years of experience in medical coding, billing, auditing and compliance.

+ Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).

+ Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.

+ Experience in an academic medical center setting is strongly preferred.

+ Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.

+ Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.

+ Must have strong interpersonal, organizational, analytical and communication skills.

+ Ability to work in a fast-paced environment.

+ Must have ability to manage multiple tasks and projects and forge strong interpersonal relationships within the department and with other departments.

+ Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential.

+ Experience researching and interpreting regulation and performing internal investigations is essential. **Licensure, Certifications, and Clearances:**

One of the following is required:

+ Certified Coding Specialist (CCS)

+ Certified Inpatient Coder (CIC)

+ Certified Evaluation & Management Coder (CEMC)

+ Certified Professional Medical Auditor (CPMA)

+ Certified Professional Coder (CPC)

+ Certified Medical Coder (CMC)

+ OR Registered Health Information Administrator (RHIA)

+ Registered Health Information Technician (RHIT)

+ OR Licensed Professional Nurse (LPN)

+ Registered Nurse (RN)

Required:

+ Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran