Compliance Auditor Sr

VCU Health • Richmond, VA

3d • Remote

About The Position

The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding process of new auditors. The Senior Compliance Auditor supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. The Senior Compliance Auditor recommends changes to improve business operations by using professional judgement and knowledge of best practices. This position contributes to special projects, as applicable. The Senior Compliance Auditor performs documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility) reviewed, education and other assistance, as needed. The Senior Compliance Auditor audits VCUHS coding and billing (DRG, CPT, HCPCS, ICD-10) based on a review of medical record documentation and/or billing claim data.

Requirements

• Permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia.
• Bachelor’s Degree in Business, Finance, Allied Health or other health related field from an accredited program.
• Combination of education and experience may be considered in lieu of a degree.
• One (1) of the following current AAPC certifications: Certified Professional Coder (CPC), Certified Professional Coder–Hospital (CPC–H), Certified Professional Coder–Payer (CPC-P), CPMA Certified Professional Medical Auditor (CPMA).
• OR One (1) of the following current AHIMA current certifications: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist–Physician Based (CCS-P).
• Minimum of five (5) years of progressively responsible experience in a healthcare environment to include, but not limited to, the following: Working with electronic health records to analyze and interpret clinical documentation for compliance purposes.
• Extensive data mining and analytic skills combined with experience using AI and advanced platforms focused on driving innovation and enhancing work efficiency.
• Conducting audits and investigations of medical records to ensure compliance, with an emphasis on risk analysis and quality assessment thorough workflow evaluation and process improvement.
• Comprehensive knowledge of CMS, OIG, and other regulatory guidelines to support compliant billing practices, with proven ability to interpret and analyze complex regulatory information effectively.
• Understanding and identifying diagnostic and procedural codes for clinical services rendered.
• Previous experience with personal computers and software applications to include Microsoft Word, Excel, PowerPoint, and data collection tools.
• Strong excel proficiency is a must.

Nice To Haves

• Seven (7) years of progressive risk auditing, coding and/or coding review experience in CPT, ICD-10; HCPCS coding and strong data mining and analysis skills.
• Five (5) years previous hospital/physician related work experience in training individuals or groups.

Responsibilities

• Performs audits of a complex nature as assigned by Compliance Audit Manager and/or Supervisor.
• Assists the Audit Manager with development of the audit schedule by performing ongoing audit software maintenance.
• Supports the Audit Manager with audit team quality assurance reviews.
• Serves as team liaison for maintenance and troubleshooting of audit software.
• Acts as a peer mentor to the compliance audit team and operates with minimal supervision.
• Conducts audits of hospital and/or physician claims to ensure compliance with all applicable federal, state, local and payor specific requirements.
• Completes two risk-based audits per month.
• Serves as the primary backup to the Compliance Educator, leading compliance education sessions for internal coders.
• Acts as the main backup to the Compliance and Audit Manager, assisting with internal training, presenting audit findings, and leading educational sessions when required.
• Facilitates and improves clinicians’, administrators' and other appropriate individuals' understanding of payor and regulatory requirements by providing feedback related to documentation and billing information.
• Works with the Compliance Educator to provide educational topics, including identifying risk-areas and changes in documentation/coding requirements; reviewing materials for Compliance Department’s approval; and teaching of general compliance education sessions as necessary.
• Coordinates Corrective Action Plan monitoring schedule and communicates progression to management.
• Assists management of departments with identified non-compliant issues in developing Corrective Action Plans to correct potential weakness and assure ongoing compliance.
• Conducts follow up reviews to ensure the Corrective Action Plans have been adequately implemented by management.
• Assists Audit Manager in collaboration with MCVP and MCVH business offices to identify and track trends of external audits.
• Actively assists Compliance Audit Supervisor in the development of the quarterly audit workplan by identifying risks through analysis of external audit and healthcare compliance activities.
• Sustains a working knowledge of relevant compliance issues, laws and regulations through periodicals, seminars, training programs, and peer contact.
• Contributes to the development and ongoing maintenance of the internal Audit Process Manual.
• Performs as a team lead with onboarding of new auditors.
• Completes research and/or special projects as requested by management.
• Prioritizes management requests based on urgency and/or risk established by Compliance Services, VCUHS Administration or the requesting agency.
• Gathers information from the correct source(s) and summarizes and prepares findings in an appropriate medium.
• Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department.
• Aids team members.
• Accepts alternate assignments, as required, graciously.

Benefits

• One college and four health sciences schools
• An academic medical center
• A Level I trauma center
• One of only two NCI-designated cancer centers in Virginia
• The region’s only full-service children’s hospital
• More than 800 physicians in 200 specialties
• With a community health center, dedicated research teams, facilities and valued partners in every field

What This Job Offers

• Job Type: Full-time
• Career Level: Senior