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Join UPMC Corporate Compliance as a Senior 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 Senior Compliance Auditor to join our team! This position will be based out of Forbes Tower in Pittsburgh, PA.

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 a Senior 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.

• Associates Degree or higher or comparable technical school diploma is required.

• 4 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.

• Knowledge of key revenue cycle processes, and clinical documentation is strongly preferred.

• Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is required.

• 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.

• Attention to detail is critical to the success of this position.

• Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.

• Data Analytics experience is strongly preferred. 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)

• Registered Health Information Administrator (RHIA)

• Registered Health Information Technician (RHIT)

• Licensed Professional Nurse (LPN)

• Registered Nurse (RN)

Required:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran