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Job Req ID:  80016

Sr. Billing Compliance Auditor Trainer

The Clinical Practice Association Billing Quality Assurance is seeking a Senior Billing Compliance Auditor Trainer who provides on-going training and support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using auditing and analysis techniques, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties.

 

This role works in close collaboration with the clinical departments, Physicians Billing Service, and the Johns Hopkins Health System Compliance Office. The documentation audits are conducted as part of the School of Medicine’s Billing Quality Assurance Compliance Program. Prepares reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. Summary results are presented to the Clinical Practice Association’s Board of Governors, the University’s Trustee Committee for Audits and Insurance and other appropriate offices within the School of Medicine or Johns Hopkins Medicine. 

 

Specific Duties & Responsibilities:

  • Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
  • Verifies and corrects as necessary, the audit work completed by the Billing Compliance Auditors or other Sr. Auditors/Trainers. 
  • Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
  • Assists departments and providers in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities.
  • Conducts training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
  • Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed.
  • Researches and answers billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.
  • Regularly monitors potential billing problems and/or billing errors identified by each departments’ professional fee billing office.
  • Prepares and revises as needed a Compliance Training Manual for routine and special training programs.
  • Assists in the development of medical record documentation standards and requirements related to clinical services billing.
  • Keeps current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.
  • Performs other compliance related activities as necessary.

 

Scope of Responsibility

  • Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division. 
  • Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

 

Decision Making                                                                                                         

  • On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area. 
  • Routinely handles confidential patient information and sensitive financial information.

 

Authority

  • Compliance Specialists may be asked to assist with training new staff or correcting the work of others. 
  • Identifies and suggests process and operational improvements.

 

Communications

  • Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

 

This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis.  It does not exclude other duties as assigned.         

 

Minimum Qualifications (Mandatory):

  • Bachelor’s Degree in health care-related or business-related field. 
  • Recent, direct experience with third party payer requirements for physicians may substitute for some education. A Master's Degree in a health care related discipline may be substituted for up to one year of experience.*
  • Minimum of four years of auditing/billing compliance required. 
  • A minimum of five years of experience preferred. 
  • Demonstrated training or teaching experience required. 
  • Additional years of related experience performed as a consultant with a recognized organization may be substituted at the rate of one year consultancy for two years of other experience.  
  • Recent experience with Medicare regulations required. 
  • Salary commensurate with experience.

 

* JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience.  Additional related experience may substitute for the required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job. 

 

** Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date. 

 

Certifications:

  • A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date. 
  • Additional coding certifications preferred.

 

Special Knowledge, Skills & Abilities:

  • Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion. 
  • Must be able to learn quickly and work independently to address a variety of complex issues. 
  • Must be flexible to adjust to the development and refinement of new processes and procedures. 
  • CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others. 
  • Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. 
  • Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred.
  • Demonstrated communication, analytical and organizational skills are essential. 
  • Demonstrated training or teaching experience required. 
  • Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.   
  • Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems preferred. 
  • Must be self-motivated and comfortable working independently, as a team leader and as a team member. 

 

Physical Requirements:

  • Sitting in a normal seated position for extended periods of time. 
  • Reaching by extending hand(s) or arm(s) in any direction.
  • Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.
  • Communication skills, using the spoken word.
  • Ability to see within normal parameters, ability to hear within normal range and ability to move about.

   

Classified Title: Sr. Billing Compliance Auditor
Working Title: Sr. Billing Compliance Auditor Trainer 
Role/Level/Range: ATP/04/PE 
Starting Salary Range: ​​​​​​​$69,830 - $95,960 annually (commensurate with experience)
Employee group: Full Time 
Schedule: M - F, 8:30 am - 5:00 pm 
Exempt Status: Exempt 
Location: ​​​​​​​Hybrid/School of Medicine Campus 

Department name: ​​​​​​​SOM Admin CPA Billing Quality Assurance 
Personnel area: School of Medicine

 

The successful candidate(s) for this position will be subject to a pre-employment background check.

 

If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the HR Business Services Office at jhurecruitment@jhu.edu. For TTY users, call via Maryland Relay or dial 711.

 

Johns Hopkins has mandated COVID-19 and influenza vaccines, as applicable. Exceptions to the COVID and flu vaccine requirements may be provided to individuals for religious beliefs or medical reasons. Requests for an exception must be submitted to the JHU vaccination registry. For additional information, applicants for SOM positions should visit https://www.hopkinsmedicine.org/coronavirus/covid-19-vaccine/ and all other JHU applicants should visit https://covidinfo.jhu.edu/health-safety/covid-vaccination-information/.

 

The following additional provisions may apply, depending on campus. Your recruiter will advise accordingly.

 

The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.

 

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