Audit & Compliance Specialist

Something special starts here. 

You can’t define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full – with joy, purpose and lifelong health – it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you’re looking for at LMH Health.

You'll find everything you’re looking for at LMH Health:

• Join a team that cares about the community
• Tuition reimbursement to support continuing education
• Professional development and recognition
• Excellent benefits

We’re looking for you.

Job Description

Job Summary

The Audit and Compliance Specialist is responsible for conducting prospective and retrospective compliance reviews of documentation supporting codes reported by providers or facility coding to ensure accuracy in billing, maximize charge capture, and comply with Federal, State, payer, and institutional requirements. This role involves analyzing medical records, ensuring the accuracy of ICD-10-CM diagnosis coding and CPT/HCPCS coding, and compliance with regulations. The specialist communicates results, makes recommendations, and provides training and education to staff on appropriate documentation, coding, and billing practices.

Essential Job Responsibilities

• Conduct coding and auditing of technical and professional components of services and procedures to ensure accuracy.
• Perform audits of new physicians on coding and documentation requirements for E/M services and procedures.
• Track coding issues by provider and present necessary education and training to improve coding.
• Demonstrate thorough knowledge of complex coding, reimbursement, and health information processes and understanding of auditing principles.
• Keep informed of third-party regulations in billing/reimbursement, professional standards, and organizational policies.
• Provide telephone and email support to staff with coding questions.
• Assist in developing written policies and procedures, auditing methodology, audit tools, and guidelines for the department.
• Perform routine and targeted Electronic Medical Record (EMR) auditing and monitoring to ensure privacy and integrity of Patient Health Information (PHI).
• Independently research and validate PHI and Compliance Audit findings.
• Perform organizational compliance risk assessments to identify strengths, vulnerabilities, and risks, and make recommendations, develop action plans, and monitor compliance.
• Assist the Director in investigating HIPAA and Compliance issues, reporting as necessary to regulatory entities, and monitoring organizational compliance initiatives.
• Implement and execute compliance audits and special projects as directed.
• Develop and present orientation and ongoing training and education materials for HIPAA and Compliance-related training.
• Analyze and evaluate medical record documentation and conduct coding/billing audits to assess the accuracy of CPT codes, diagnoses, and modifier assignments.
• Collaborate with colleagues on audits and other projects, producing high-quality work in accordance with department standards.
• Develop reports from audit results and assess the need for further review or intervention.
• Participate in the preparation and delivery of compliance education and training programs and remedial education with staff.
• Conduct follow-up audits to appraise the adequacy of corrective actions and determine whether deficiencies are corrected.
• Serve as a coding, documentation, and policy and procedure resource to provide regulatory guidance and education to staff.
• Research relevant regulations and communicate the need for policies and procedures and education.
• Maintain a current working knowledge of regulatory requirements associated with professional coding, billing, documentation, and reporting requirements.
• Seek ongoing training and development to gain additional expertise to ensure an effective compliance program.
• Maintain professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations, and reviewing current literature.
• Perform other duties as needed or assigned.

Job Qualifications

Required:

• Certification in Physician Coding, CPC or CCS-P, with in-depth knowledge of ICD/CPT coding.
• CEMC (Certification for Evaluation and Management Coder) or CPMA (Certified Professional Medical Auditor) obtained within the first year.
• Five years’ experience in physician coding and billing with a working knowledge of healthcare operations.
• Familiarity with documentation and coding requirements for physicians, including Medical Staff By-laws, Clinical Standards, Regulatory Compliance, and Risk Management.
• Excellent communication, organization, analytical, and problem-solving skills.
• Current coding certification through AAPC or AHIMA.
• Excellent interpersonal skills and ability to collaborate and interact well with physicians, non-physician practitioners, staff, and leadership.

Preferred:

• Experience with recent Medicare audit in a physician practice setting.
• Multi-Specialty coding or auditing experience.
• Advanced technical knowledge in specific surgical and medical specialties (e.g., Orthopedics, Neurosurgery/Spine, Oncology, OB/GYN).

Our Cultural Beliefs

• People First 
• Integrity Matters
• Better Together

At LMH Health, we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.