1.  Primary responsibility is to complete audits of departmental compliance chart reviews and to participate in audits requested by third party payors. 2.  Assess provider documentation for IDC-10 and CPT-4 coding accuracy, compliance with University and government regulations.   3.  Obtain and review charge documents, encounter forms, medical records and billing procedures. 4.  Evaluate results, identify system control weaknesses and in conjunction with department management, develop plan of action and solutions based on audit results.  5.  Participate in the implementation of corrective action changes.  6.  Design and maintain accurate tracking logs, including spreadsheets, of all ongoing investigations. 7.  Follow up on corrective action. Report findings to the Compliance Officer, PFS and University Auditor as needed.8.  Conduct training sessions with individual physicians and/or departments on medical billing compliance.  Provide input on areas and subjects where education is needed.   9.  Advise and assist in development of training materials and programs for clinical and billing staff relative to accurate coding, documentation billing and regulatory guidelines.10. Conduct data analysis.  Generate reports using Query tools to identify trends and problem areas for focus of internal audits. 11. Participate in the ongoing implementation of the Compliance Program. Knowledge of University Medical Billing Compliance Plan, operations and procedures.  12. Stay abreast of best practice coding and auditing practices and regulatory changes. Maintain CPC designation by obtaining necessary CEUs on an annual basis. 

Required Skill/ability 1:  Four years' demonstrated ability in healthcare compliance, or related ; multi-faceted healthcare company or University compliance, or academic/medical compliance  and/or with compliance investigations, patient relation investigations, confidential communications, attorney-directed reviews, conflicts of interest, employee relations and other compliance activities.

Required Skill/ability 2:  Strong oral and written communication skills and interpersonal skills. Ability to communicate thoughts, ideas, information and messages with clear language, style, organization and format appropriate to the subject matter, purpose and audience.

Required Skill/ability 3:  Possesses excellent critical thinking skills, including the ability to identify a problem, determine the root cause, communicate findings and participate in the development of the solution.

Required Skill/ability 4:  Capable of managing difficult conversations with sensitivity and the ability to respond to confidential information with objectivity and discretion.

Preferred Education:  Master's degree preferred or equivalent combination of education and experience. Prior experience in revenue cycle operations preferred, such as coding, billing, collections, account reconciliation or other patient financial services functions.

Work Week:  Standard (M-F equal number of hours per day)

Posting Position Title:  Compliance Auditor

University Job Title:  Compliance Investigation Analyst

Preferred Education, Experience and Skills:  Master's degree preferred or equivalent combination of education and experience. Prior experience in revenue cycle operations preferred, such as coding, billing, collections, account reconciliation or other patient financial services functions.

Bachelor's in Health Care Management, Finance, Business or Nursing or a related field.  Five years' experience in multi-specialty group practice, academic plan or hospital or an equivalent combination of educational and experience.

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