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Job Details

Requisition Number 18-0027
Title Compliance Auditor I, Charge Capture & Billing
Location UVA Research Park
City Charlottesville
State VA
Hours per week Full time
Description POSITION TITLE: Compliance Auditor I, Charge Capture & Billing
JOB CODE: B3129(b)
LEVEL/FLSA: 13 Exempt
DEPARTMENT: Charge Capture & Billing
REPORTS TO: Manager, Charge Capture & Billing

GENERAL SUMMARY: The Charge Capture & Billing, “CCB”, Compliance Auditor 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 for those departments coded and billed by CCB.


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.
 Prepares written reports of the results of the audits, including recommendations for improvement and compliance with state and federal laws and regulations, and UPG policies.
 Presents the audit reports and results to management and staff.
 Provides coding and documentation guidance to medical and coding staff and management as needed.
 Conducts follow-up audits if indicated to appraise the adequacy of corrective actions and determine whether deficiencies are corrected; prepares the appropriate reports for management.
 Represents UPG as a member of various committees as assigned by the manager.
 Develops, documents, and assists in implementing policies and procedures to ensure compliance with third-party requirements and to minimize corporate risk.
 Works on joint projects with other audit staff and UPG units to resolve billing and documentation issues and acts as the expert on compliance related topics.
 Participates as an active member on the QA Team.
 Performs coding and/or billing as governed by work volumes as requested.
 Works with CCB and Billing Quality, “BQ”, staff to ensure compliance and other audit issues identified are included in future training and education programs.
 Keeps abreast of related coding guidelines and reporting requirements. Maintains professional skills and knowledge through educational programs; participates in professional organizations; and/or reviews current literature.
 Demonstrates a strong commitment to the mission and values of the organization.
 Completes other projects as assigned by the Manager.

SUPERVISORY RESPONSIBILITIES: This position does not have any positions reporting to him/her but may review others’ work and act as a team leader.

WORKING CONDITIONS: General office environment.

UPG is an Equal Opportunity Employer
Requirements REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):

 Bachelor’s Degree and 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.
 Prefer RHIA or RHIT 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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