Compliance Auditor

Unified Women's Healthcare

15h

About The Position

Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this but executing on it. As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates – enabling them to focus solely on the practice of medicine while we focus on the business of medicine. We are action oriented. We strategize, implement and execute – on behalf of the practices we serve. The Compliance Auditor performs comprehensive audit of care center locations/divisions. Reviews patient chart documentation for accuracy of Evaluation and Management (E/M) service levels, modifier use, in-office procedures, and diagnosis codes for services performed by OB/GYN physicians and other qualified healthcare providers. Evaluate key administrative, operational, compliance, and regulatory requirements. Communicates with providers verbally and in written report format. Informs leadership and the Executive team of audit findings, potential deficiencies, develops and monitors corrective action plans. Communicate with upline management of identified trends and areas of risk. Provides recommendations for improvement in the patient experience, clinical outcomes, and the documentation system to mitigate risk to the Company.

Requirements

• Certified Professional Coder (CPC) credentialed with a minimum of three years of medical coding experience in the area of specialty or similar certification with the ability to obtain the CPC within six months from the hire date.
• All auditors must maintain a valid and current coding certification.
• Recommend having at minimum a bachelor’s degree in business or healthcare administration, or a related field.

Nice To Haves

• OB/GYN experience and the Certified Professional Medical Auditor (CPMA), Certified Obstetrics and Gynecology Coder (COBGC) certifications or the like are preferred.
• Experience in surgical coding is a plus. May also have any related nursing degree.

Responsibilities

• Performs pre-and post-billing chart reviews to ensure the clinical documentation provides evidence of compliance with coverage requirements, Company policy, and regulatory requirements including evaluation and management, surgery, radiology, pathology, and medicine.
• Communicates with the Compliance/Legal Department any reportable findings or matters identified during the audit that would put the Company at risk.
• Communicates and informs the care center locations/divisions and leadership of audit findings and corrective action plans.
• Prepares accurate, concise, and timely written executive summary of findings and coordinates all provider education sessions.
• Provides feedback to the Compliance Department and Company departments regarding recommended revisions or updates to Company policies, education opportunities, and documentation system enhancements.
• Adheres to all Company’s policies and procedures, the Code of Conduct, the Employee Handbook, the mandatory Ethics and Compliance, and HIPAA privacy and security programs.
• Participates in special projects and performs other duties as assigned.

What This Job Offers

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