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Title: Medical Oncology Compliance Auditor

Business Unit: U.S. Pharmaceutical Solutions and Services

Practice Management

Position Summary

We are seeking a highly skilled Medical Oncology Compliance Auditor to conduct internal coding and billing audits and reviews. These audits ensure a layer of protection and compliance of fee-for-service billing and documentation records, verifying the accuracy of code assignments in line with the Center for Medicare and Medicaid Services (CMS), Medicare Administrative Contractor (MAC), and various state regulations. The ideal candidate will resolve complex issues using creativity and sound judgment within established policies, while anticipating changes and adjusting efforts accordingly.

Key Responsibilities

Conduct coding and billing reviews and audits in accordance with Compliance department standard operating procedures.Comprehend and adhere to department procedures related to billing and coding audits and reviews.Complete audits/reviews within designated timeframes to minimize impact on results.Analyze results of billing and coding audits to identify patterns, trends, and variations in coding, documentation practices, operational workflows, and billing practices, ensuring adherence to federal payor guidelines.Prepare reports of findings and recommendations for improvement for internal review and distribution to business leaders and Compliance leadership.Collaborate with the education group to ensure that audit findings are accurate and accessible for training purposes.Maintain up-to-date knowledge of E&M, CPT, and ICD-10-CM coding and coding guidelines.Identify, apply, and validate current federal payor guidelines and industry-standard clinical indicators, risk factors, and treatment protocols for clinical validation of payment-impacting code assignments.Perform reviews and audits using medical records to assess the documentation against base code sets impacting payment, ensuring compliance with Medicare, Medicaid, and other federal payor guidelines.Validate E&M, CPT, and ICD-10-CM codes assigned for Medicare, Medicaid, and other government payors based on provider selection.Document results and necessary corrections clearly, providing supporting evidence from medical records and authoritative guidance.Maintain professional standards when providing feedback to managers and other leadership members.Possess experience and knowledge of Medical Oncology and Hematology coding and documentation.

Additional Skill

Ensure strict confidentiality of patient information.Meet or exceed production and quality standards and expectations.Achieve short-term and long-term departmental goals.Participate in staff meetings and attend other required meetings and seminars.Adapt to dynamic environments where plans may change based on business and environmental drivers.Work independently and proactively with urgency and tact.Exhibit extreme detail orientation with the ability to track requirements to work plans.Proficiency in Microsoft Word, Excel, and PowerPoint.

Minimum Requirements

6+ years of relevant experience.

Critical Skills

At least 4 years of auditing experience and 2 years of coding experience.Active CCS-P or CPC certification.Demonstrated knowledge of Medical Terminology, Anatomy & Physiology, and expertise in federal payor guidelines, third-party payer reimbursement, coding, and documentation requirements.Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).

Other Requirements

General office demands.Flexible working hours may be required.Completion of a coding assessment may be requested.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here.

Our Base Pay Range for this position

$73,500 - $122,500

McKesson is an Equal Opportunity Employer

 

McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

 

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