Healthcare Compliance Audit Analyst (Must have CPC, CCS-P, or CPMA)

U.S. Urology Partners

4d•Remote

About The Position

U.S. Urology Partners, LLC (USUP) and its physician groups are committed to promoting responsible, ethical, and legally compliant conduct. The Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with healthcare laws and regulations. A key function of USUP’s compliance program is auditing and monitoring adherence to billing, coding, and documentation requirements by its providers. This role requires a CPC, CCS-P, or CPMA certification. The compliance audit initiatives include physician, other provider, and facility documentation audits, as well as the creation of guidance documents and tools to aid physicians and staff in appropriate billing, coding, and documentation practices. The audit program focuses on professional fee billing, coding, and documentation, along with other areas identified by the CD. Annual audits are determined based on the current Office of Inspector General Workplan, its Compliance Guidance’s, and compliance risk analyses. Reporting to the Compliance Director, the Compliance Audit Analyst is responsible for the timely and effective completion of Health Care Integrity Program documentation audits and risk assessment projects for coding, documentation, and billing accuracy as identified by the organization, CD, and the Office of the Inspector General. Specific audit details are outlined in annual work plans developed by USUP’s CD and communicated to USUP’s leadership team.

Requirements

CPC, CCS-P, or CPMA certification required.
Experience with using and navigating through an electronic medical record system.
Knowledge of state, federal, local, and payer-specific regulations and policies pertaining to documentation, coding, and billing is required.
Demonstrated capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment is required.
Ability to think abstractly and concretely required.
Ability to develop reports, presentations, and spreadsheets required.
Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, Access, and Internet Explorer is required.
Outstanding verbal and written communication skills is required.
Experience in handling complex organizational projects; and an excellent problem identification and solution skill to address difficult, complex issues is required.
Ability to gain the trust and confidence of the providers, compliance team and billing staff.

Nice To Haves

Bachelor's degree in health administration, health information management, or another related field preferred.
Minimum of three years of experience in healthcare compliance, healthcare operations, coding and/or documentation auditing in a healthcare organization is preferred.

Responsibilities

Conduct physician/provider and facility documentation audits.
Ensure accuracy of data entered into the CD Internal Audit Database and prepare reports for audited providers, department leadership, and organization leadership.
Analyze audit data and provide summary feedback to clinic and billing staff, making recommendations for improvement.
Work with the billing and coding departments to determine charge corrections and refunds resulting from compliance audits.
Work closely with the billing department to help minimize denial issues to achieve appropriate reimbursements.
Receive and respond to audit, documentation, and coding review requests from the billing department.
Perform research for numerous billing and coding scenarios.
Provide input in the development and improvement of procedures used to complete the audit function.
Assist in conducting formal/informal education sessions for the purpose of educating and training physicians, non-physician providers, and other staff.
Identify additional opportunities to improve education of physicians, non-physician providers and staff.
Prepare and produce billing/coding/documentation communication for use as guidance documents, website content, newsletter content, education content, and other communication channels, in collaboration with the billing and coding departments.
Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff.
Identify education/awareness opportunities and guidance topics based on types of questions/issues received.