Trillium Health, a Federally Qualified Health Center Look-Alike, is a community health center offering access to affordable care for all, with a special focus on meeting the needs of LGBTQ people, communities of color, and underserved populations.
Nationally recognized for outstanding patient-centered care, the team at Trillium Health provides a wealth of knowledge and experience. Our expansive array of services, including testing and treatment, laboratory services, primary and specialty care, and an on-site pharmacy, makes it easier for patients and clients to receive the complete care they need, all in one place.
Our authentic commitment to diversity and inclusion is evidenced through our hiring practices, our employee programs, and our compassion for everyone we serve. Based in downtown Rochester, with satellite locations in Bath and Geneva, and MOCHA centers in Buffalo and Rochester, Trillium is deeply invested in building community. We proudly sponsor many other nonprofit organizations throughout the area and participate in a wide range of community events.
Trillium’s employee-centered company culture and exceptional benefits have contributed to impressive growth in recent years, raising our staff total to more than 250. We hope you will consider joining us on this upward path and becoming a part of the Trillium Health family.
We are currently recruiting for a RN Auditor, Compliance Coding
Audit & Coding Compliance
Ability to review and evaluate medical records for the appropriateness and medical necessity of services and procedures billed based on supporting documentation.
Knowledgeable regarding ICD10 and CPT codes, billing guidelines, payer policies, and related industry standards.
Develop audit work plans and perform audit functions in all billable programs including Medicaid and Medicare.
Prepare written and oral communication to the Compliance Committee members and appropriate individuals regarding audit results.
Provide professional documentation/coding training and advice as appropriate.
Develop policies and procedures pertaining to all audits/coding checks that are routinely performed.
Assist with follow-up responses for external audits/site visit findings and plans of correction identified by funders/payers.
Provide back-up for Risk Management/Audit Coordinator for other compliance audits as needed.
Requires the ability and commitment to respect and support inclusiveness and diversity including but not limited to individuals of different backgrounds, cultures, races, ages, sexual orientations, gender identities or expressions, experiences, opinions, etc.
Requires individual demonstration of commitment to the One Trillium behaviors and business impacts and modeling them in the organization.
Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
Accountable for meeting the performance standards of the Compliance department and conduct and participate as requested in compliance audits, process improvement and quality improvement plans.
Other specific duties as assigned.
Knowledge, Skills & Abilities
Ability to demonstrate clinical expertise in the areas of urgent/emergent, medical/surgical, gynecological, pediatric and/or ambulatory care.
Ability to communicate effectively, verbally and in writing e.g. audit reports, procedural manuals and prepare business correspondence.
Capacity to interact diplomatically with physicians and other professionals by expressing ideas clearly and concisely.
Ability to review medical records to assess clinical data and draw conclusions.
Ability to define problems, collect data, establish facts and draw conclusions.
Ability to interpret an extensive variety of technical instructions and manage several abstract and concrete variables.
Knowledge of billing guidelines, payer policies, and related industry based standards.
Must be knowledgeable in Medicare and Medicaid billing and payment criteria.
Bachelor’s degree required. Concentration in Nursing, Health Information Management, Business Administration or a related field preferred. Master’s degree preferred. Seven years of combined experience in clinical, facility/physician billing, compliance and/or internal audit environment required. Reimbursement principles, claims processing and healthcare compliance concepts required.
Trillium Health offers employment to all employees & applicants. No person shall be discriminated against in employment on the basis of race, age, color, marital status, religion, creed, sex, sexual orientation, gender identity or expression, national origin or ancestry, disability, veteran status, status as a domestic violence victim, genetic condition or predisposition, or any other characteristic protected by law.