Sr Clinical Compliance Prof. RCM & Coding Auditor
HumanaFull Time
Senior (5 to 8 years)
Candidates must have any graduation, preferably in Finance/Accounting, with 5 years of compliance experience, including 3+ years in medical coding auditing. A medical coding certificate such as CCS-P, CPC, or CPCA is required, and a compliance certification (CHC) is preferred. Proficiency in Excel, including pivot tables, lookups, and advanced formulas, is essential, along with strong knowledge of compliance programs and systems. The role requires the ability to prioritize work, exercise sound judgment, manage multiple tasks effectively, and possess strong attention to detail, analytical thinking, and organizational skills. Excellent problem-solving, critical thinking, and communication skills are also necessary, along with strong PC/MAC skills and familiarity with Microsoft Office Suite.
The Compliance Auditor will perform internal compliance audits and support external audits by reviewing records, reports, software, and related activities. This includes auditing other auditors or vendors, preparing written reports of audit results with recommendations, and monitoring corrective action plans to ensure necessary changes are made. The role involves generating and maintaining all audit documentation, reports, and recommendations, as well as communicating audit results and findings to the compliance analyst, Senior Director, and key stakeholders. Additionally, the Compliance Auditor will provide ongoing status reports, create and update compliance reports and metrics, and assist with operations support by tracking Jira tickets, incidents, and issues within areas of oversight.
Specialty-specific electronic health record systems
Modernizing Medicine provides specialty-specific Electronic Health Records (EHR) systems designed to improve the workflow of healthcare providers. Their main products, EMA and gGastro EHR, help users manage patient information and administrative tasks more efficiently, allowing them to concentrate on patient care. These systems adapt to the specific practices of each user, enhancing their effectiveness. Unlike many competitors, Modernizing Medicine focuses on tailored solutions for various medical specialties, which sets them apart in the healthcare technology market. The company's goal is to streamline healthcare delivery and improve patient outcomes by providing tools that simplify administrative processes.