Under general supervision of the Government Audit Department Team Leader, the Regulatory Auditor reviews a wide range of government audit denials. The primary role of the Regulatory Auditor is to review denials and appeal those which are found to be unsubstantiated through review of the medical record and/or billing information. The Regulatory Auditor is responsible for tracking assigned cases and data entry of audit related information into SSM's web-based audit tracking tool. Through analysis and interpretation of audit findings, the Regulatory Auditor supports staff education, quality improvement, policy development, and overall improvement of financial performance.
Position Requirements (General):
EDUCATION: Bachelor's Degree
CERTIFICATION, liCENSURE, BONDING: RHIA/RHIT
EXPERIENCE: Minimum of 3 years' experience in hospital inpatient coding.
Preference will be shown for candidates with a strong working knowledge of coding practices and regulations, possessing a Certified Coding Specialist (CCS) certification
Needs experience in clinical documentation improvement (ex. Clinical Documentation Specialist), possessing one or more of the following credentials: CDIP, CCDS is desired. Additionally, previous healthcare compliance experience, with knowledge of the revenue cycle and regulatory environment is desired.
Strong attention to detail and highly developed analytical skills enabling review and comprehension of complex audit denials. Ability to research, interpret and apply healthcare rules and regulations as they pertain to incoming audit denials. Ability to communicate complex Medicare guidelines to key stakeholders. Exceptional letter writing skills required for composition of accurate, thorough and clear appeal letters. Solid working knowledge of Microsoft Excel and Word. Ability to navigate multiple PC-based systems, as well as SSM's financial and electronic health record systems. Ability to run, export, and analyze reports using the organization's audit tracking tool. Must work well under pressure, organizing workload and prioritizing tasks effectively, while meeting multiple and sometimes competing deadlines.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same