System Compliance Auditor

University of Vermont Health; Vermont; Presencial; USD 90.000 - 115.000; Jornada completa

Descripción de la vacante

University of Vermont Health is seeking a System Compliance Auditor to identify and assess risks in documentation, coding, and billing while helping avoid potential fines from government agencies. You will develop orientation for new providers and perform annual provider billing audits, providing ongoing education to staff involved in professional bill submissions to federal payers.

The role collaborates with billing departments, HIM, Revenue Integrity, and leadership to ensure compliance with

Formación

• Bachelor's degree in business, health care operations or clinical field required.
• Five years of work-related experience in coding and billing for professional services and one year of auditing experience.
• Master's degree preferred; certification by AAPC (CPC-E/M) preferred.

Responsabilidades

• Identify and assess risks in documentation, coding and billing processes.
• Perform annual audits of provider billing.
• Report audit findings to billing providers and leadership.
• Develop and support the annual Compliance Audit Work Plan.
• Provide ongoing education to providers and staff on compliance and billing practices.

Conocimientos

Auditing

Medical coding & billing

Regulatory compliance knowledge

Educación

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

Master's degree in business or health care related field

AAPC CPC-E/M Auditor certification

Descripción del empleo

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 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.