Compliance Audit Specialist II - Physician Billing Compliance

University of Florida; Gainesville (FL); On-site; USD 33,000 - 36,000; Full time

Benefits offered by this job

Low-cost State Health Plans

Life and Disability Insurance

Generous Retirement Options

Comprehensive Paid Time Off

Tuition Assistance

PSLF Eligible Employer

Job summary

University of Florida's College of Medicine seeks a Compliance Audit Specialist II to conduct regulatory audits of departments, institutes and centers. The role reviews medical and billing records to ensure service and documentation meet federal and state regulations.

You will collaborate with the Compliance Audit Specialist manager and Director of Physician Billing Compliance, contribute to audit findings, and help develop training materials to strengthen the compliance program.

Qualifications

• High School Diploma or equivalent required; college coursework may substitute for experience.
• CPC/CCS-P/CCA/CHC/CHRC/CHPC/CCEP/CCEP-I credentials required or preferred.

Responsibilities

• Audit the University of Florida College of Medicine departments for data integrity and regulatory compliance.
• Document findings clearly and communicate patterns of error that affect institutional risk.
• Support development of training content and assist in educational program improvements.
• Assist with training sessions for providers and billing staff; stay current with coding changes.

Skills

Medical terminology

Coding knowledge

CMS guidelines

Communication skills

Education

High School Diploma or equivalent

Tools

PowerPoint

Access

Job description

Classification Minimum Requirements

High School Diploma or equivalent and two years of appropriate experience. Appropriate college course work may substitute at an equivalent rate for the required experience.

Classification Title

Compliance Audit Specialist II

Classification Minimum Requirements

High School Diploma or equivalent and two years of appropriate experience. Appropriate college course work may substitute at an equivalent rate for the required experience.

Certified Professional Coder (CPC)/ American Academy of Professional Coders or Certified Coding Specialist (CCS-P) (American Health Information Management Association) or Certified Coding Associate (CCA) (American Health Information Management Association) or Certified in Healthcare Compliance (CHC) or Certified in Healthcare Research Compliance (CHRC) or Certified in Healthcare Privacy Compliance (CHPC) or Certified Compliance & Ethics Professional (CCEP) or Certified Compliance & Ethics Professional-International (CCEP-I) is required

Job Description

The Compliance Audit Specialist conducts regulatory compliance audits of the University of Florida, College of Medicine departments, institutes and centers to ensure data integrity and compliance with federal and state regulations, reviewing medical and billing records to determine if service and documentation requirements are met. Works in collaboration with the Compliance Audit Specialist manager and Director of Physician Billing Compliance to provide input and assist in the development of any applicable training and education content.

About This Role

• Conduct compliance audits of the University of Florida College of Medicine departments, institutes, and centers to ensure data integrity, compliance with federal and state regulations pertaining to, but not limited to provider billing services. Reviews medical and billing records to determine if service and documentation requirements are met. Clearly documents findings related to work performed. Communicate any identified patterns of error that may create institutional risk.
• Contributes to audit findings report and assist in the organization of documentation to support and communicate audit findings. May direct/supervise clerical search of paper or electronic health records. These findings may lead to substantive refunds to the College of Medicine, and/or disciplinary action for faculty, residents, non-physician providers and operational staff.
• Drafts summary reports, communications with physicians, compilation of findings, discussion of findings. Familiarizes with the structure of our clinical practice and participates in recommendations on educational and internal control policies to improve compliance plan effectiveness and operational outcomes.
• Assist with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis
• Responsible for current reading to remain appraised of coding changes, and seek institutional interpretations.
• Researches current federal, state and payer documentation, billing and coding rules and regulations.

About The College Of Medicine

The University of Florida's College of Medicine is committed to advancing health through education, research, and patient care. With a focus on innovation and excellence, the college prepares future healthcare leaders through a rigorous curriculum that combines basic sciences with hands-on clinical experience. The College of Medicine emphasizes interdisciplinary collaboration and community engagement, fostering and environment where students, faculty, and staff work together to improve healthcare outcomes. The College is home to cutting-edge research initiatives and state-of-the-art facilities, providing an exceptional training ground for aspiring medical professionals. Dedicated to enhancing health care, the College of Medicine plays an impactful role in shaping the future of medicine.

For more information about the College of Medicine and its programs, visit College of Medicine .

We Offer Exceptional Benefits

• Low-cost State Health Plans: Medical, Dental, and Vision Insurance
• Life and Disability Insurance
• Generous Retirement Options to secure your future
• Comprehensive Paid Time Off Packages with 10+ paid holidays, paid family, sick and vacation leave
• Exceptional Personal and Professional Development Opportunities: Access to UF Training & Organizational Development programs, leadership development, LinkedIn Learning, and more
• Tuition Assistance through the UF Employee Education Program
• Public Service Loan Forgiveness (PSLF) Eligible Employer

Expected Salary

$23.94 - $26.34 per hour; commensurate with education and experience.

Required Qualifications

High School Diploma or equivalent and two years of appropriate experience. Appropriate college course work may substitute at an equivalent rate for the required experience.

Certified Professional Coder (CPC)/ American Academy of Professional Coders or Certified Coding Specialist (CCS-P) (American Health Information Management Association) or Certified Coding Associate (CCA) (American Health Information Management Association) or Certified in Healthcare Compliance (CHC) or Certified in Healthcare Research Compliance (CHRC) or Certified in Healthcare Privacy Compliance (CHPC) or Certified Compliance & Ethics Professional (CCEP) or Certified Compliance & Ethics Professional-International (CCEP-I) is required

Preferred

The ideal candidate will possess:

• CPC or CHC credentials highly preferred.
• Proficiency with medical terminology.
• Proficiency with procedural coding (including Level II HCPCs) and diagnosis coding.
• Proficiency with Evaluation and Management guidelines and CMS Teaching Physician regulations.
• Ability to manage and impart confidential information.
• Ability to manage multiple priorities and deadlines.
• Ability to work independently and as part of a team.
• Ability to deliver presentations.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies.
• Advanced working knowledge of Microsoft Word and Excel software in a Windows environment.
• Experience with PowerPoint and Access in a Windows environment a plus.
• Experience with management information systems and medical software.
• Ability to gather data, compile information, and prepare reports.
• Previous supervisory experience preferred
• Previous compliance auditing experience required
• Experience with Medicare, Medicaid, and Tricare/Champus regulations pertaining to billing and reimbursement required

Health Assessment Required

No