Revenue Cycle Dental Compliance Auditor (Remote)

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus – a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Works independently performing program, compliance and risk-based reviews of dental related activities to ensure accuracy of dental related medical record documentation, coding, billing and policies. Provides written audit summary of findings to include audit recommendations. Conducts revenue cycle investigations to determine and mitigate dental risk through findings, reports, and recommended actions through an action plan. Coordinates, develops and conducts educational training based on audit outcomes. Creates educational resources based off audit findings. Provides educational training to dental clinical staff on documentation requirements and correct coding of dental services. Assists corporate compliance in maintaining the hospital’s corporate compliance program.

Job Requirements:

Education and Work Experience:
• Associate’s Degree or equivalent combination of education/related experience: Required
• Bachelor’s Degree: Preferred
• Five years’ experience in reading dental records, dental coding and billing: Required
• Three years’ experience in auditing dental services: Preferred

Licenses/Certifications:
• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist — Physician (CCS-Phy): Required
• Dental certificate either from the AAPC or ADA: Preferred

Facility Specific License/Certifications:
• CCS OR CPC OR CCS-Phy: Required

Essential Functions:
• Performs comprehensive reviews of dental records for accuracy of revenue cycle billing compliance to include but not limited to: medical necessity, compliance risk, review of denials, charge trends, and applied CDT, ICD 10-CM coding guidelines for dental visit encounters that correlates to visit documentation.
• Produces comprehensive audit finding reports that include quantifiable impact, identify areas of opportunity for education, as well as improvement recommendations. Generates audits utilizing auditing platform for denials, coding reviews and other risk-based data for department audits as appropriate.
• Communicates clearly (verbally and in written reports or summaries) opportunities regarding proper dental documentation guidelines, service selection, charge capture and timely submission, dental data accuracy and coding principles.
• Participates in improving the efficient and effective delivery of the department’s services including promoting the department brand, complying with department and professional standards, participating in department initiatives and internal process improvement projects, and providing input into the enhancement of audit methodologies, workflows and tools. Participates in annual risk assessment and work plan development processes.
• Assists with other audits being rendered within the revenue cycle compliance department, ambulatory.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.