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Job Details

Requisition Number 18-0085
Title Compliance Auditor II
Location University Avenue
City Charlottesville
State VA
Hours per week Full Time
Description POSITION TITLE: Compliance Auditor II
JOB CODE: B3130 LEVEL/FLSA: 14, Exempt
REPORTS TO: Manager, Audit

GENERAL SUMMARY: The Compliance Auditor II is responsible for conducting audits of medical documentation and other compliance practices utilizing his/her professional expertise and judgment to ensure the University of Virginia Physician’s Group is compliant with state and federal laws, regulations and other guidance. He/she will report on the results of audits to the manager and use professional judgment and knowledge of best business practices to recommend changes to improve business operations.

Essential functions of the job:
 Conducts internal audits of medical documentation to ensure the documentation adequately supports the provider service billed in accordance with the appropriate third party regulations and/or standards.
 Conducts audits on other compliance related topics as determined by the Audit Risk Analysis to evaluate UPG’s compliance with state and federal laws, regulations and policy.
 Prepares written reports of the results of the audits, including recommendations for improvement and compliance with stated and federal laws and regulations, and UPG policies.
 Presents the audit reports and audit results to management.
 Represents UPG as a member of various committees as assigned by manager.
 Develops, documents, and assists in implementing policies and procedures to ensure compliance with third-party requirements and to minimize corporate risk.
 Participates in developing and maintaining Compliance Audit Standards.
 Works on joint projects with other audit staff and HSF units to resolve billing and documentation issues and act as the expert on compliance related topics.
 Participates as an active member on the QA Team.
 Manages the post pay audit process to include, RAC, CERT, PERM and other programs.
 Works with the Billing Quality staff to ensure compliance and other audit issues identified are included in future training and education program.
 Performs quality assurance activities for the audit function.
 Completes other projects as assigned by Manager.
Requirements REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):
 Bachelor’s Degree and/or commensurate level of healthcare auditing / physician billing experience in large institutional setting
 2-3 years of compliance audit experience with CCS-P or CPC certification (or obtained within 6 months of hire); or five or more years related work experience with CCS-P or CPC Certification.
 Experience in CPT-4, HCPCS and ICD-10 coding.
 In-depth knowledge of third-party payer reimbursement, coding, and documentation requirements.
 Knowledge of Medicare and Medicaid regulations required.
 Experience in a teaching/academic medical environment a plus.
 Knowledge of physician billing.
 Prefer previous audit experience.
Knowledge and skills:
 Demonstrated analytical and research experience.
 Basic knowledge of and experience utilizing a personal computer.
 Intermediate word processing, spreadsheet, presentation, and database software skills required.
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