Could you be our next Compliance Auditor IPPS/OPPS with Main Line Health?

Make an Impact! Compliance Auditor Inpatient Perspective Payment System/Outpatient Perspective Payment System (IPPS/OPPS) reviews inpatient hospital claims for proper reimbursement and handles provider disputes in a result-oriented and metrics-driven environment. The Inpatient Compliance Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters, and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods in conjunction with Audit Manager and requires minimal direction and receives guidance where needed.

 

In accordance with current federal & state coding compliance regulations and guidelines, the Compliance Auditor IPPS/OPPS performs 2nd level reviews of previously coded inpatient accounts for MS-DRG validation purposes—including the accuracy and completeness of all ICD-10-CM and ICD-10-PCS code assigned by inpatient coders. Ensure appropriate MS-DRG & APR-DRG, including SOI & ROM scores. Performs 2nd level reviews of variables affecting MS-DRG and/or APR-DRG—such as—HACs, PSIs, Elixhauser Comorbidities, etc.

Develop and Grow your Career! Invest in furthering your education through seeking certifications or advanced degrees by taking advantage of our Tuition Reimbursement! This position is eligible for up to $6,000 per year based upon your Full or Part Time status.

Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a purpose: providing superior service and care.

Position-Specific Benefits: You are eligible for up to 200 hours of paid time off per year. We also offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!

Position: Compliance Auditor IPPS/OPPS
Shift: Day Shift, Monday - Friday

Experience:

Minimum of 5 years’ experience performing inpatient coding reviews and audits required. Must possess and maintain one of the following active certifications for at least four years:

Certified Coding Specialist (CCS)

Registered Health Information Technician (RHIT)

Registered Health Information Administrator (RHIA)

Certified Inpatient Coder (CIC)

At least 5 years of work experience in MS-DRG and APR-DRG coding/auditing required. Minimum of 3 years’ experience in ICD-10-CM/PCS coding and auditing within a Level 1 Trauma hospital required.

Education:

Associate’s degree in business/health administration with two years of experience within a coding environment or a Bachelor’s degree in Healthcare Administration is required.

Formal ICD-10-CM, ICD-10-PCS, CPT-4 training required.

Additional Information Requisition ID: 75030 Employee Status: Regular Benefit Eligibility: Full-Time Benefits Schedule: Full-time Shift: Day Job Pay Range: $70,012.80 - $108,492.80 Job Grade: 112