System Compliance Auditor

University of Vermont Medical Center; Burlington (VT); On-site; USD 85,000 - 110,000; Full time

Job summary

The University of Vermont Medical Center is seeking a System Compliance Auditor to identify and assess risks in documentation, coding and billing processes. This role helps prevent government penalties by ensuring compliance with state and federal regulations related to healthcare documentation, coding, reporting, and billing for health care services.

The position performs annual provider billing audits, delivers orientation training for new providers, and supports ongoing education for

Qualifications

• Bachelor's degree in business, health care operations or a clinical field required.
• Substantial work-related experience as an auditor, along with academic credentials, may serve as a substitute.
• Master's degree in business or health care related field preferred.
• Must possess certification issued by the American Academy of Professional Coders (AAPC).
• Certification as CPC-E/M Auditor preferred.

Responsibilities

• Identify billing related risk areas and conduct audits of such risk areas.
• Report audit findings to billing providers and leaders, and recommend corrective actions.
• Develop annual Compliance Audit Work Plan and ensure policies conform to requirements.
• Provide orientation training for new providers and ongoing education to staff involved in professional billing.

Skills

Auditing

Regulatory compliance

Coding & billing knowledge

Training & education

Communication

Education

Bachelor's degree in business, health care operations or clinical field

Master's degree in business or health care related field

AAPC certification

CPC-E/M Auditor certification preferred

Job description

Job Summary:
The System Compliance Auditor identifies and assesses risks in the organization's documentation, coding and billing processes and assists in the avoidance of potential fines and penalties from government agencies. They serve as a resource for the UVM Health to ensure the System is compliant with applicable state and federal regulations as they relate to documentation, coding, reporting, and billing of health care services. The System Compliance Auditor does this by developing and providing orientation training for new providers, performing annual audits of provider billing, and providing on-going education to providers and employees, especially those involved in the preparation and/or submission of professional bills to federal payers.

The System Compliance Auditor is responsible for reporting audit findings to billing providers, as well as administrative and clinical leaders and non-clinical staff, and making recommendations based on the audit findings. They also work closely with several other departments in the System including the professional and hospital billing departments (Professional Revenue Department and Patient Financial Services), the Coding Education team, Health Information Management (HIM), Revenue Integrity, and management and physician leaders among various Medical Group clinics.

The System Compliance Auditor is responsible for identifying billing related risk areas, conducting audits of such risk areas, and recommending measures to reduce risk and promote compliance with applicable rules. The System Compliance Auditor assists with the development of the annual Compliance Audit Work Plan and ensures that organizational policies and audit standards conform to such requirements. To do this, they must keep current on all applicable state and federal regulations pertaining to documentation, coding and billing and ensuring that departmental guidance and department audit standards conform to such requirements.

Education:
Bachelor's degree in business, health care operations or a clinical field required. Substantial work-related experience as an auditor, along with academic credentials, may serve as a substitute. Master's degree in business or health care related field preferred. Must possess certification issued by the American Academy of Professional Coders (AAPC). Certification as CPC-E/M Auditor preferred.

Experience:
Must possess five years of work-related experience in coding and billing for professional services and one year of auditing experience.