Compliance Audit Specialist II - Physician Billing Compliance

University of Florida • Gainesville, FL

20h • Onsite

About The Position

The Compliance Audit Specialist 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, reviewing medical and billing records to determine if service and documentation requirements are met. Works in collaboration with the Compliance Audit Specialist manager and Director of Physician Billing Compliance to provide input and assist in the development of any applicable training and education content.

About this Role:
Conduct compliance audits of the University of Florida College of Medicine departments, institutes, and centers to ensure data integrity, compliance with federal and state regulations pertaining to, but not limited to provider billing services. Reviews medical and billing records to determine if service and documentation requirements are met. Clearly documents findings related to work performed. Communicate any identified patterns of error that may create institutional risk. Contributes to audit findings report and assist in the organization of documentation to support and communicate audit findings. May direct/supervise clerical search of paper or electronic health records. These findings may lead to substantive refunds to the College of Medicine, and/or disciplinary action for faculty, residents, non-physician providers and operational staff. Drafts summary reports, communications with physicians, compilation of findings, discussion of findings. Familiarizes with the structure of our clinical practice and participates 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 Responsible for current reading to remain appraised of coding changes, and seek institutional interpretations. Researches current federal, state and payer documentation, billing and coding rules and regulations.

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, compliance with federal and state regulations pertaining to, but not limited to provider billing services.
• Reviews medical and billing records to determine if service and documentation requirements are met.
• Clearly documents findings related to work performed.
• Communicate any identified patterns of error that may create institutional risk.
• Contributes to audit findings report and assist in the organization of documentation to support and communicate audit findings.
• May direct/supervise clerical search of paper or electronic health records.
• Drafts summary reports, communications with physicians, compilation of findings, discussion of findings.
• Familiarizes with the structure of our clinical practice and participates 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.
• Responsible for current reading to remain appraised of coding changes, and seek institutional interpretations.
• Researches 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED