Compliance Auditor Senior - Remote

JOB DESCRIPTION

The Senior Compliance Auditor serves as an employee of the University of Vermont Medical Center who is permanently assigned to OneCare Vermont as a member of its Workforce. The Senior Compliance Auditor serves to educate, encourage and assist those within OneCare’s community to always "do things right." The Senior Compliance Auditor does this by: (i) developing and providing both annual training for Members of OneCare’s Workforce as well as on-going education of Members of OneCare’s Network involved in the preparation and/or submission of claims for the payment of professional services; (ii) serving as an organization and Network-wide resource for and authority on issues related to the documentation, coding, and billing of professional services; (iii) coordinating internal review and educational activities with Coding Educators and Compliance contacts within the Network; (iv) monitoring and auditing claims data provided by OneCare’s Payers relating to payment prepared on behalf of individual billing providers in OneCare’s Network in accordance with their organization's Provider Coding and Billing-related policies; (v) conducting internal quality assurance activities; (vi) identifying claims-submission and billing-related areas of risk for potential fraud, waste, and abuse, and conducting audits of such risk areas; (vii) reporting on audit findings to OneCare’s Chief Compliance and Privacy Officer, administrative leaders, and Compliance Committee, and making recommendations based upon audit findings (e.g., identifying opportunities aligned with OneCare’s goals of as an ACO and the Vermont All-Payer Model); (viii) keeping current on all applicable legal and regulatory requirements and ensuring that departmental guidance and audit standards conform to such requirements; (ix) reviewing and developing departmental, organizational, and Network policies and procedures that promote compliance with all applicable legal and regulatory requirements; (x) engaging in special investigations in response to external requests for records and audits; and (xi) being an "ethics champion."

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. Certification as CPC-E/M Auditor preferred; otherwise, must obtain CPC-E/M Auditor certification within one year of date of hire.

EXPERIENCE:

Must possess five years of work related experience in coding and billing for professional services and, at least, two years of auditing experience.