Compliance Audit Specialist II - Physician Billing Compliance
About The Position
The Compliance Audit Specialist II conducts regulatory compliance audits of the University of Florida, College of Medicine departments, institutes, and centers to ensure data integrity and compliance with federal and state regulations. This role involves reviewing medical and billing records to determine if service and documentation requirements are met. The specialist collaborates with the Compliance Audit Specialist manager and Director of Physician Billing Compliance to provide input and assist in the development of training and education content. Key responsibilities include conducting audits, documenting findings, communicating identified patterns of error, contributing to audit reports, and potentially directing clerical searches of records. The role may lead to substantive refunds or disciplinary actions. The specialist will also draft summary reports, communicate with physicians, compile findings, and participate in recommendations for improving compliance. Assisting with training sessions for providers and billing staff, staying current with coding changes and institutional interpretations, and researching federal, state, and payer rules and regulations are also core functions.
Requirements
- High School Diploma or equivalent and two years of appropriate experience.
- Appropriate college course work may substitute at an equivalent rate for the required experience.
- Previous compliance auditing experience required
- Experience with Medicare, Medicaid, and Tricare/Champus regulations pertaining to billing and reimbursement required
Nice To Haves
- CPC or CHC credentials highly preferred.
- Proficiency with medical terminology.
- Proficiency with procedural coding (including Level II HCPCs) and diagnosis coding.
- Proficiency with Evaluation and Management guidelines and CMS Teaching Physician regulations.
- Ability to manage and impart confidential information.
- Ability to manage multiple priorities and deadlines.
- Ability to work independently and as part of a team.
- Ability to deliver presentations.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Advanced working knowledge of Microsoft Word and Excel software in a Windows environment.
- Experience with PowerPoint and Access in a Windows environment a plus.
- Experience with management information systems and medical software.
- Ability to gather data, compile information, and prepare reports.
- Previous supervisory experience preferred
Responsibilities
- Conduct compliance audits of the University of Florida College of Medicine departments, institutes, and centers to ensure data integrity and compliance with federal and state regulations pertaining to provider billing services.
- Review medical and billing records to determine if service and documentation requirements are met.
- Clearly document findings related to work performed.
- Communicate any identified patterns of error that may create institutional risk.
- Contribute to audit findings reports and assist in the organization of documentation to support and communicate audit findings.
- May direct/supervise clerical search of paper or electronic health records.
- Draft summary reports, communications with physicians, compilation of findings, and discussion of findings.
- Familiarize with the structure of the clinical practice and participate in recommendations on educational and internal control policies to improve compliance plan effectiveness and operational outcomes.
- Assist with the development of training sessions for providers, professional fee billing staff, and others on a regularly scheduled or ad hoc basis.
- Remain current with coding changes and seek institutional interpretations.
- Research current federal, state, and payer documentation, billing, and coding rules and regulations.
Benefits
- Low-cost State Health Plans: Medical, Dental, and Vision Insurance
- Life and Disability Insurance
- Generous Retirement Options to secure your future
- Comprehensive Paid Time Off Packages with 10+ paid holidays, paid family, sick and vacation leave
- Exceptional Personal and Professional Development Opportunities: Access to UF Training & Organizational Development programs, leadership development, LinkedIn Learning, and more
- Tuition Assistance through the UF Employee Education Program
- Public Service Loan Forgiveness (PSLF) Eligible Employer
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
