Sr. Compliance Auditor Trainer

Johns Hopkins, founded in 1876, is America's first research university and home to nine world-class academic divisions working together as one university.

We are seeking a Sr. Compliance Auditor Trainer who will provide 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. 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 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 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.
• Research 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.
• May be asked to assist with training new staff or correcting the work of others. Identifies and suggests process and operational improvement.
  

• 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.
  

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

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.
• Knowledge of CPT and ICD-9 coding 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 reimbursements.
• Knowledge of related clinical and business practices, policies, and procedures for billing and collections.
• Demonstrated communication, analytical and organizational skills are essential.
• 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.

Minimum Qualifications

• Bachelor’s Degree in health care-related or business-related field.
• Four years of auditing/billing compliance.
• One professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.
• Demonstrated training or teaching experience.
• Additional education may substitute for required experience and additional experience may substitute for required education, to the extent permitted by the JHU equivalency formula.

Preferred Qualifications

• Experience with Epic Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, IDX and other clinical information systems.
• Seven years of experience.
• Additional coding certifications.

Classified Title: Sr. Billing Compliance Auditor
Job Posting Title (Working Title): Sr. Compliance Auditor Trainer
Role/Level/Range: ATP/04/PE
Starting Salary Range: $73,300 - $128,300 Annually ($100,800 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30A-5PM
Exempt Status: Exempt
Location: Hybrid/Mount Washington Campus
Department name: ​​​​​​​Office of Compliance: Prof Fee Services
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.

The following additional provisions may apply depending on which campus you will work. Your recruiter will advise accordingly.

During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.

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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