Coding & Compliance Eye Auditor

VMG HOLDINGS LLC•Dallas, TX

About The Position

VMG Health is seeking an experienced Ophthalmic Compliance Auditor to join its Coding Audit and Compliance (CAC) team. The role provides auditing, compliance, education, and consulting services to a broad range of healthcare clients, including physician practices, hospitals, health systems, academic medical centers, law firms, and private equity organizations. The auditor serves as a subject matter expert and trusted resource for clients and internal team members on coding and documentation, supporting documentation audits, provider education, due diligence, and compliance engagements. The position involves reviewing medical records and applying healthcare regulatory and payer guidance to audit findings and recommendations. The auditor communicates results to providers, operational leaders, attorneys, executives, and other stakeholders, and helps deliver client projects on time, within scope, and within budget. Some travel is required. The description emphasizes the ability to work independently in a remote work environment but does not explicitly state the job's workplace type.

Requirements

At least 5–10 years of hands-on experience in a practice setting as a skilled technician, scribe, or clinic manager, with a strong understanding of clinical operations and diseases common in ophthalmology and/or optometry; alternatively, at least 3 years of healthcare auditing, documentation review, compliance, or regulatory experience. (The posting's description of the alternative qualification is incomplete.)
Strong knowledge of CPT, HCPCS, ICD-10, ophthalmology/optometry-related codes, and related CMS guidelines.
Thorough understanding of and adherence to HIPAA regulations.
Familiarity with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing procedures.
Commitment to staying current on developing issues and requirements in medical coding procedures.
Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, and healthcare reimbursement principles.
Ability to evaluate complex documentation scenarios and apply nuanced regulatory guidance to support defensible audit conclusions.
Strong written communication skills, including audit report writing, corrective-action development, and executive-level communications.
Strong organizational, communication, analytical, problem-solving, and time-management skills to keep pace with fast-moving client projects.
Ability to facilitate provider education effectively.
Ability to identify trends, interpret data, and develop practical, risk-based recommendations.
Professionalism and executive presence when interacting with clients and stakeholders.
Willingness to collaborate with established team members to reach consensus on billing and coding issues.
Flexible, collaborative approach to variable daily tasks and internal and external customer types.
Dedication to high-quality, detail-oriented work.
Self-directed and motivated, able to work independently, prioritize responsibilities, and maintain productivity in a remote work environment.
Tech-savvy, with experience using Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint.
Willingness to achieve coding certification(s).
Some travel is required.

Nice To Haves

Experience auditing professional coding in ophthalmology and/or across multiple specialties and service settings.
Experience analyzing payer policies, regulatory guidance, and reimbursement requirements and translating findings into actionable recommendations.
Experience presenting written reports to providers, executives, and/or compliance leadership.
Experience working independently in a consulting or client-service environment.
JCAHPO certification (COA, COT, or COMT) and/or CPC, CPMA, OCS, and/or COPC is desired.
COE is highly beneficial.
Preferred certifications: CPMA, CHC, CPCO, CRC, RHIA, RHIT, and COC.
Specific expertise in ophthalmology is highly desirable.

Responsibilities

Work as part of an audit team to complete client projects professionally and successfully, meeting productivity and quality standards within deadlines.
Access medical record documentation from client EMR and practice-management systems.
Analyze medical records for chart content and documentation requirements.
Use audit reporting tools to document results and prepare reports for quality-assurance review and client delivery.
Interpret and apply CMS, AMA, OIG, NCCI, and other payer guidance to audit findings and compliance recommendations.
Identify documentation, coding, billing, and risk trends and communicate findings to clients and internal leadership.
Prepare and present audit results, executive summaries, and compliance recommendations to providers, administrators, and senior leadership.
Develop reports of audit findings and corrective-action plans based on identified issues.
Conduct education and training sessions for internal team members and clients as directed.
Educate providers and serve as a resource on documentation and compliance matters.
Participate in quality-assurance reviews and peer-review activities to promote consistent and accurate audit outcomes.
Assist with developing and maintaining audit tools, educational materials, methodologies, and compliance resources.
Coordinate, research, and access resources needed to execute client projects.
Assist leadership in ensuring client projects are delivered on time, within scope, and within budget.
Support development and clarification of project scope and objectives, engage relevant stakeholders, and confirm project feasibility.
Develop and maintain relationships with clients and key stakeholders.
Review quality-assurance audit reports and implement necessary corrections and adjustments.
Maintain current knowledge of government regulatory compliance guidance and third-party payer requirements.
Maintain awareness of healthcare auditing principles, practices, and related compliance topics.
Use Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, to complete assigned tasks.