Healthcare Compliance Audit Analyst (Must have CPC, CCS-P, or CPMA)

LE0002 U.S. Urology Partners, LLC; United States; À distance; USD 65 000 - 90 000; Plein temps

Avantages offerts par ce poste

Health/Dental/Vision benefits

HSA/FSA

401(k) matching

Employee Assistance Program

Résumé du poste

U.S. Urology Partners, LLC is seeking a Compliance Audit Analyst to join the Compliance Department. The role focuses on health care billing, coding, and documentation audits, with reporting to the Compliance Director and annual work plans guiding audits.

The analyst will conduct physician/provider and facility audits, prepare reports, analyze data, and collaborate with billing and coding teams to improve accuracy, minimize denials, and educate staff through formal and informal sessions.

Qualifications

• Bachelor's degree in health administration, health information management, or related field preferred; CPC/CCS-P/CPMA required.
• 3+ years of experience in healthcare compliance, healthcare operations, coding, or documentation auditing.
• Strong verbal and written communication skills; ability to develop reports and presentations.

Responsabilités

• Conduct physician/provider and facility documentation audits.
• Prepare reports for audited providers and leadership.
• Analyze audit data and provide feedback and recommendations.
• Collaborate with billing/coding to determine charge corrections and refunds.
• Educate physicians and staff through formal/informal sessions.

Connaissances

Verbal and written communication

Report development

Independent work

Problem solving

Formation

Bachelor's degree in health administration/health information management or related field

CPC

CCS-P

CPMA

Outils

Microsoft Word

Microsoft Excel

Outlook

PowerPoint

Access

Internet Explorer

Description du poste

General Summary

U.S. Urology Partners, LLC (USUP) and its physician groups are committed to promoting conduct that is responsible, ethically sound, and compliance with applicable law. USUP’s Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and reimbursement of health care. An integral function of USUP’s compliance program is auditing and monitoring compliance with billing, coding, and documentation requirements of its providers. An CPC, CCS-P, or CPMA is required for this position.

Compliance Audit Services

Compliance audit initiatives include physician, other providers, and facility documentation audits as well as preparation of guidance documents and tools to assist physicians and staff in appropriate billing, coding, and documentation. The audit program looks at professional fee billing, coding, and documentation as well as other areas that are identified by the CD. The audits to be performed each year are identified based on the then-current Office of Inspector General Workplan, its Compliance Guidance’s, and compliance risk analyses. Reporting to the Compliance Director, the Compliance Audit Analyst is responsible for the timely and effective completion of Health Care Integrity Program documentation audits and risk assessment projects for coding, documentation and billing accuracy as identified by the organization, CD, and the Office of the Inspector General. The specifics of the audits are outlined in related annual work plans created by USUP’s CD and communicated to USUP’s leadership team.

Essential Functions

• Conduct physician/provider and facility documentation audits.
• Ensures accuracy of data entered into the CD Internal Audit Database and prepares reports for audited providers, department leadership, and organization leadership.
• Analyze audit data and provides summary feedback to clinic and billing staff, making recommendations for improvement.
• Works with the billing and coding departments to determine charge corrections and refunds resulting from compliance audits.
• Works closely with the billing department to help minimize denial issues so that appropriate reimbursements are achieved.
• Receives and responds to audit, documentation, and coding review requests from the billing department.
• Performs research for numerous billing and coding scenarios.
• Provide input in the development and improvement of procedures used to complete the audit function.
• Assist in conducting formal/informal education sessions for the purpose of educating and training physicians, non-physician providers, and other staff.
• Identify additional opportunities to improve education of physicians, non-physician providers and staff.
• Working with the billing and coding departments, prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels.
• Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff.
• Based on types of questions/issues received, identify education/awareness opportunities and guidance topics.

Other Functions

Position requires an individual with expertise in health information and clinical documentation audits. Adherence to internal audit schedule and other deadlines is necessary.

Qualifications

• Experience with using and navigating through an electronic medical record system.
• Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required.
• Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required.
• Ability to think abstractly and concretely required.
• Ability to develop reports, presentations, and spreadsheets required.
• Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access, and Internet Explorer is required.
• Outstanding verbal and written communication skills is required.
• Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required.
• Ability to gain the trust and confidence of the providers, compliance team and billing staff.

Minimum Requirements

Bachelor's degree in health administration, health information management, or another related field preferred. CPC, CCS-P, or CPMA, required. Experience minimum of three years of experience in healthcare compliance, healthcare operations, coding and/or documentation auditing in a healthcare organization is preferred.

Work Hours

This is a remote position, typical work hours for the Compliance Auditor Analyst will be Monday through Friday 8:30 A.M. until 5:00 P.M. with a half hour meal break. When normal business hours are extended due to practice needs the Compliance Billing Auditor may be requested to provide coverage. Candidate must be located in the Eastern United States and be willing to travel as needed.

Working Conditions

Work is normally performed in an office setting and requires prolonged sitting.

Physical Demands

Physical requirements needed to perform the job are eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate documents.

Position Reports to

Compliance Director, USUP

What We are Offer You

At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Every Family Matters Compassion Make Someone’s Day Collaboration Achieve Possibilities Together Respect Treat people with dignity Accountability Do the right thing Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.

About US Urology Partners

U.S. Urology Partners is one of the nation’s largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery. U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.

Equal Opportunity Employer

U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.