System Compliance Auditor

UVM Health; Northern (KY); Hybrid; USD 75,000 - 110,000; Full time

Job summary

UVM Health is seeking a System Compliance Auditor to identify and assess risks in documentation, coding and billing processes and help avoid penalties from government agencies. The role involves developing orientation training for new providers and performing annual audits of provider billing, with ongoing education for staff involved in professional bills to federal payers.

The auditor reports findings to billing providers, administrative and clinical leaders, and collaborates with multiple

Qualifications

• Five years of work experience in coding and billing for professional services.
• Minimum one year of auditing experience.
• Must possess AAPC certification (CPC).
• Substantial work-related experience as an auditor may substitute for education.

Responsibilities

• Identify billing related risk areas and conduct audits.
• Report audit findings to providers and leadership and make recommendations.
• Develop annual Compliance Audit Work Plan and ensure policy conformance.
• Provide orientation and ongoing education to providers and staff on coding and documentation.
• Collaborate with billing, HIM, Revenue Integrity and clinical leadership.

Skills

Auditing

Coding & Billing

Compliance

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)

CPC-E/M Auditor certification

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.