Physician Compliance Auditor II
Baylor Scott & White Health · United States
- Hybrid
- Full-time
- $83,200 / year
- United States
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Job highlights
- Audit physician documentation for compliance and accuracy.
- Conduct reviews and create coding work plans.
- Educate providers on documentation guidelines.
- Serve as a coding compliance consultant.
- Develop and assist with compliance policies.
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, and 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
- Medical Auditing
- Coding Accuracy
- ICD-10
- CPT Codes
- HCPCS
- Compliance Reporting
- Healthcare Regulations
- Provider Education
- Documentation Review
Skills & topics
- Physician Compliance Auditor
- Medical Auditing
- Coding Compliance
- ICD-10
- CPT
- HCPCS
- Healthcare Compliance
- Remote
- Auditing Experience
- CPC
- CCS-P
- Healthcare
How to get hired
- Tailor your resume: Highlight 4+ years of physician auditing experience, CPT, ICD-10, and HCPCS knowledge.
- Emphasize certifications: Clearly list CPC, CCS-P, or equivalent certifications on your application.
- Showcase expertise: Detail your experience with E/M, surgical, and diagnostic procedures across multiple specialties.
- Demonstrate skills: Mention proficiency in Word, Excel, PowerPoint, and research abilities in your application.
- Prepare for interviews: Be ready to discuss your auditing findings and educational strategies for providers.
Technical preparation
Master CPT, ICD-10, and HCPCS coding guidelines.,Practice auditing Pro-Fee services thoroughly.,Gain experience with E/M and surgical coding.,Familiarize yourself with compliance regulations.
Behavioral questions
Describe a complex compliance issue you resolved.,How do you educate providers on documentation?,How do you handle differing opinions on audits?,Explain your research process for compliance topics.
Frequently asked questions
- What are the key qualifications for the Physician Compliance Auditor II role at Baylor Scott & White Health?
- The Physician Compliance Auditor II role at Baylor Scott & White Health requires a Bachelor's degree or 4 years of equivalent work experience, along with at least 4 years of physician auditing experience. A strong understanding of CPT, ICD-10, and HCPCS is essential, as is an active coding certification such as CPC or CCS-P. Experience with various service lines and specialties is also crucial.
- Is the Physician Compliance Auditor II position at Baylor Scott & White Health remote?
- Yes, the Physician Compliance Auditor II position at Baylor Scott & White Health is a 100% remote role, offering flexibility and the ability to work from anywhere.
- What is the salary range for the Physician Compliance Auditor II position at Baylor Scott & White Health?
- The salary range for the Physician Compliance Auditor II position at Baylor Scott & White Health is between $26.66 and $40.00 per hour, depending on the candidate's specific qualifications and prior experience. This range reflects both entry-level and highly experienced candidates.
- What types of services and specialties will a Physician Compliance Auditor II at Baylor Scott & White Health audit?
- A Physician Compliance Auditor II will audit documentation and coding accuracy for outpatient, inpatient, and emergency services. This includes E/M services, surgical procedures, and diagnostic procedures across multiple specialties such as Cardiology, Orthopedics, Family Medicine, and Internal Medicine.
- What certifications are preferred for the Physician Compliance Auditor II role?
- While an active CPC or CCS-P certification is required, preferred certifications for the Physician Compliance Auditor II role include CHC, AHFI, or CFE. These additional certifications can further demonstrate expertise in compliance and auditing.
- How does Baylor Scott & White Health support employee growth and development for a Physician Compliance Auditor II?
- Baylor Scott & White Health supports employee growth through various benefits, including immediate eligibility for health and welfare benefits, a 401(k) savings plan with a company match, and tuition reimbursement. This demonstrates a commitment to professional development and well-being for their employees.