Physician Compliance Auditor II
Baylor Scott & White Health · Dallas, TX
- On site
- Full-time
- $83,200 / year
- Dallas, TX
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Job highlights
- Audit physician documentation for compliance and accuracy.
- Conduct coding reviews and create work plans.
- Educate providers on documentation guidelines and coding.
- Serve as a coding compliance consultant.
- Develop policies and submit compliance reports.
About the role
About Us
Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.
Our Core Values Are
- We serve faithfully by doing what's right with a joyful heart.
- We never settle by constantly striving for better.
- We are in it together by supporting one another and those we serve.
- We make an impact by taking initiative and delivering exceptional experience.
Benefits
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level.
Job Summary
The Physician Compliance Auditor II audits and evaluates compliance activities to ensure documentation meets standards. Establishes audit scope, uses tools, compiles data, reports findings, and provides recommendations and training. Audits may include documentation and coding accuracy for outpatient, inpatient, and emergency services using ICD-10, CPT, HCPCS, and other guidelines. Coding across multiple services lines, E/M services, surgical procedures, diagnostic procedures, and multiple specialties including: Cardiology, Orthopedics, Family Medicine, Internal Medicine.
Work Model & Salary
100% Remote
The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.
Essential Functions Of The Role
- Performs chart audits and formulates recommendations based upon the audit findings and communicates them to the appropriate personnel.
- Implements coding reviews and creates work plans based on them. Ensures compliance issues and risks are identified and addressed.
- Develops curriculum for educating providers and staff on medical record documentation guidelines. Educates on diagnostic and procedural coding conventions and methodologies.
- Acts as a coding compliance and documentation resource and consultant for all providers, company administrators, and clinical staff.
- Assists in developing policies and procedures on coding compliance for clinics and the compliance department.
- Prepares and submits compliance reports to the compliance committee.
- Cross-trains other Physician Compliance Auditors in their area(s) of expertise to provide more depth and flexibility to the department.
Key Success Factors
- Advanced knowledge of CPT, ICD-10, and HCPCS.
- CHC, AHFI, or CFE certification preferred.
- Maintains working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the compliance department.
- Ability to research complex topics regarding compliance and coding efficiently and accurately.
- Able to explain compliance concerns and resolutions clearly and concisely. Comfortable discussing them with all organization members.
- Proficient in Word, Excel, and PowerPoint.
- Four years auditing experience.
Qualifications
- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
- EXPERIENCE - 4 Years of Experience Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM
- Coding experience across multiple service lines, E/M services, Surgical procedures, Diagnostic procedures, Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine
- CERTIFICATION/LICENSE/REGISTRATION - Active coding certification: CPC (Verified through AAPC) or CCS-P (Verified through AHIMA) required.
- Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM
- Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Cert Prof Coder Physician (CPC-P): Must have one of the following: Cert Coding Spec Physician based (CCS-P), Cert Professional Coder (CPC), or Cert Prof Coder Physician (CPC-P).
Belonging Statement
We believe that all people should feel welcomed, valued and supported.
Key skills/competency
- Physician Compliance Auditor
- CPT Coding
- ICD-10 Auditing
- HCPCS Coding
- Medical Documentation
- Compliance Reporting
- Healthcare Auditing
- Pro-Fee Auditing
- Provider Education
- Regulatory Requirements
Skills & topics
- Physician Compliance Auditor
- Healthcare Compliance
- Medical Auditing
- CPT Coding
- ICD-10
- HCPCS
- Pro-Fee Auditing
- Remote
- Healthcare
- Compliance
How to get hired
- Customize your resume: Highlight your 4 years of auditing and coding experience, CPT, ICD-10, and HCPCS knowledge, and any relevant certifications like CPC or CCS-P.
- Tailor your application: Emphasize your experience with Pro-Fee services, E/M, surgical, and diagnostic procedures across multiple specialties to align with the job requirements.
- Prepare for interviews: Be ready to discuss your experience in compliance, regulatory requirements, and how you educate providers. Showcase your proficiency in Word, Excel, and PowerPoint.
- Demonstrate your skills: Provide examples of how you have identified and addressed compliance risks, developed training materials, or contributed to policy development.
- Research the company: Understand Baylor Scott & White Health's mission, values, and commitment to community well-being to show your alignment.
Technical preparation
Master CPT, ICD-10, and HCPCS coding.,Practice Pro-Fee auditing across specialties.,Review E/M, surgical, and diagnostic coding.,Gain proficiency in Word, Excel, PowerPoint.
Behavioral questions
Describe a complex compliance issue you resolved.,How do you educate providers on coding guidelines?,How do you manage multiple audit projects?,How do you ensure accuracy in your findings?
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Frequently asked questions
- What are the key technical skills required for the Physician Compliance Auditor II role at Baylor Scott & White Health?
- The Physician Compliance Auditor II role at Baylor Scott & White Health requires advanced knowledge of CPT, ICD-10, and HCPCS coding systems. Proficiency in auditing Pro-Fee services, including E/M services, surgical procedures, and diagnostic procedures across various specialties like Cardiology, Orthopedics, Family Medicine, and Internal Medicine is essential. Familiarity with standard office software such as Word, Excel, and PowerPoint is also necessary.
- Does Baylor Scott & White Health offer benefits for remote employees for the Physician Compliance Auditor II position?
- Yes, Baylor Scott & White Health provides benefits for remote employees. While specific details may vary by position, benefits typically include immediate eligibility for health and welfare benefits, a 401(k) savings plan with a dollar-for-dollar match up to 5%, and Tuition Reimbursement. PTO accrual also begins on Day 1.
- What kind of experience is necessary to be considered for the Physician Compliance Auditor II role?
- For the Physician Compliance Auditor II position, you need at least 4 years of auditing experience specifically for Pro-Fee (providers) services, with a strong focus on CPT and ICD-10-CM coding. Experience in coding across multiple service lines and specialties is also a key requirement.
- Are there specific certifications preferred for the Physician Compliance Auditor II job at Baylor Scott & White Health?
- Yes, while not strictly mandatory, a coding certification such as CPC (Certified Professional Coder) from AAPC or CCS-P (Certified Coding Specialist-Physician-based) from AHIMA is required. Additionally, certifications like CHC (Certified in Healthcare Compliance), AHFI, or CFE are preferred.
- What is the salary range for a Physician Compliance Auditor II at Baylor Scott & White Health?
- The pay range for the Physician Compliance Auditor II position at Baylor Scott & White Health is between $26.66 and $40.00 per hour. The exact hourly rate will be determined based on the successful candidate's specific qualifications and prior experience.
- Is the Physician Compliance Auditor II position at Baylor Scott & White Health a remote role?
- Yes, the Physician Compliance Auditor II position at Baylor Scott & White Health is a 100% remote role, allowing you to work from anywhere.