Compliance Auditor

JOB DESCRIPTION:

The 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 Network to ensure the Network is compliant with applicable state and federal regulations as they relate to documentation, coding, reporting, and billing of health care services. The 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 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 Network 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 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 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.