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Healthcare Compliance Audit Analyst (Must have CPC, CCS-P, or CPMA)
<div><p><u><span>General Summary:</span></u><span> </span></p></div><div><p><span><span>U.S.</span><span> Urology Partners</span><span>, LLC</span><span> (USUP</span><span>)</span><span> and its p</span><span>hysician</span><span> groups</span><span> </span><span>are</span><span> committed to promoting conduct that is responsible, ethically sound, and complian</span><span>ce</span><span> with applicable law. </span><span>USUP’s </span><span>Compliance Department (CD) fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and </span><span>reimbursement</span><span> of health care. </span><span>An int</span><span>egral </span><span>function of USUP</span><span>’</span><span>s compliance program is auditing and monitoring </span><span>compliance with billing, coding, and documentation requirements</span><span> of its providers</span><span>. </span> <b>An <span>CPC, CCS-P, or CPMA is </span><span>required for this position</span><span>.</span></b></span><b><span> </span></b></p></div><div><p><span> </span></p></div><div><p><u><span>Compliance Audit Services:</span></u><span> </span></p></div><div><p><span><span>Compliance audit initiatives include physician, other </span><span>providers,</span><span> and facility documentation audits as well as preparation of guidance documents and tools to </span><span>assist</span><span> physicians</span><span> and staff in </span><span>appropriate billing</span><span>, </span><span>coding,</span><span> and documentation. </span><span> </span><span>The audit program looks at professional fee billing, coding, and documentation</span><span> as well as other areas that are </span><span>identified</span><span> by the CD</span><span>.</span><span> </span><span> The audits to </span><span>be performed</span><span> each year are </span><span>identified</span><span> based on the then-current Office of Inspector General Workplan</span><span>, its Compliance </span><span>Guidance’s</span><span>,</span><span> and compliance risk analyses</span><span>.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><span><span>Reporting to the </span><span>Compliance Director</span><span>, the Compliance Audit Analyst </span><span>is responsible for</span><span> the </span><span>timely</span><span> and effective completion of Health Care Integrity Program documentation audits and risk assessment projects for coding, documentation and billing accuracy as </span><span>identified</span><span> by the organization, CD, and the Office of the Inspector General. The specifics of the audits </span><span>are outlined</span><span> in related annual work plans created by </span><span>USUP’s </span><span>CD and communicated to </span><span>USUP’s </span><span>leadership team.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><div><p><u><span>Essential Functions:</span></u><span> </span></p></div><div><ul><li><p><span><span>Conduct physician/provider and facility documentation audits. </span></span><span> </span></p></li><li><p><span><span>Ensures accuracy of data </span><span>entered into</span><span> the CD Internal Audit Database and prepares reports for audited </span><span>providers</span><span>, department leadership, and organization leadership. </span></span><span> </span></p></li><li><p><span><span>Analyze audit data and </span><span>provides</span><span> summary feedback to clinic and billing staff, making recommendations for improvement. </span></span><span> </span></p></li><li><p><span><span>Works with the billing and coding departments to </span><span>determine</span><span> charge corrections and refunds resulting from compliance audits.</span></span><span> </span></p></li></ul></div></div><div><div><ul><li><p><span><span>Works </span><span>c</span><span>losely with the billing department to help minimize denial issues so that </span><span>appropriate reimbursements</span><span> </span><span>are achieved</span><span>.</span></span><span> </span></p></li><li><p><span><span>Receives and responds to audit, documentation, and coding review</span><span> </span><span>requests from the billing department.</span></span><span> </span></p></li><li><p><span><span>Performs research for </span><span>numerous</span><span> billing and coding scenarios.</span></span><span> </span></p></li><li><p><span><span>Provide</span><span> input in the development and improvement of procedures used to complete the audit function.</span></span><span> </span></p></li><li><p><span><span>Assist</span><span> in conducting formal/informal education sessions for the purpose of educating and training </span><span>physicians</span><span>, non-physician providers, </span><span>and other staff.</span><span> </span></span><span> </span></p></li></ul></div></div><div><div><ul><li><p><span><span>Identify</span><span> </span><span>additional</span><span> opportunities to improve education of </span><span>physicians,</span><span> non-physician providers</span><span> and staff.</span></span><span> </span></p></li><li><p><span><span>Working with the billing and coding departments, p</span><span>repare and produce <span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">billing/coding/documentation</span> communication for use as guidance documents, website content, newsletter content, education content, and other communication channels. </span></span><span> </span></p></li><li><p><span><span>Develop materials for use in education and communication derived from audit findings for feedback to physicians, department billing staff, and other compliance staff.</span></span><span> </span></p></li><li><p><span><span>Based on types of questions/issues received, </span><span>identify</span><span> education/awareness opportunities and guidance topics.</span></span><span> </span></p></li></ul></div><div><p><span> </span></p></div></div><div><div><p><u><span>Other Functions:</span></u><span> </span></p></div><div><ul><li><p><span><span>Position requires an individual with </span><span>expertise</span><span> in health information and clinical documentation audits.</span></span><span> </span></p></li><li><p><span><span>Adherence to internal audit schedule and other deadlines is necessary.</span></span><span> </span></p></li></ul></div><div><p><span> </span></p></div><div><p><u><span>Qualifications:</span></u><span> </span></p></div></div><div><div><ul><li><p><span><span>Experience with using and navigating through an </span><span>electronic medical </span><span>record </span><span>system</span><span>. </span></span><span> </span></p></li><li><p><span><span>Knowledge of state, federal, local, and payer-specific regulations and policies </span><span>pertaining to</span><span> documentation, coding, and billing </span><span>is </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Demonstrated </span><span>capacity</span><span> to work independently in an organized, detailed manner while </span><span>maintaining</span><span> a collaborative team environment </span><span>is </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Ability to think abstractly and concretely </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Ability to develop reports, presentations, and spreadsheets </span><span>required</span><span>.</span></span><span> </span></p></li></ul></div></div><div><div><ul><li><p><span><span>Strong computer skills including the ability to effectively use software applications such as Microsoft Word, Excel, Outlook, PowerPoint, </span><span>Access,</span><span> and Internet Explorer </span><span>is</span><span> </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Outstanding verbal and written communication skills </span><span>is</span><span> </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Experience in handling complex organizational projects; and </span><span>an excellent</span><span> problem identification and solution </span><span>skill</span><span> to address difficult, complex issues is </span><span>required</span><span>.</span></span><span> </span></p></li><li><p><span><span>Ability to gain </span><span>the </span><span>trust and confidence of </span><span>the providers, </span><span>compliance team </span><span>and billing staff</span><span>.</span></span><span> </span></p></li></ul></div><div><p><span> </span></p></div></div><div><p><span><span> </span></span><span> </span></p></div><div><p><u><span>Minimum</span><span> Requirements</span></u><span> </span></p></div><div><p><span><span>Bachelor's degree in health administration, health information management, or </span><span>another</span><span> related field </span><span>preferred</span><span>.</span><span> CPC, CCS-P, or CPMA, </span><span>required</span><span>.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><span> </span></p></div><div><p><u><span>Experience</span></u><span> </span></p></div><div><p><span><span>Minimum</span><span> of three years of experience in healthcare compliance, healthcare operations</span><span>,</span><span> coding and/or documentation auditing in a healthcare organization </span><span>is </span><span>preferred</span><span>.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><u><span>Work Hours: </span></u><span> </span></p></div><div><p><span><span>This is a remote position, </span><span>t</span><span>ypical work hours for the Compliance </span><span>Auditor Analyst</span><span> will be Monday through Friday 8:30 A.M. until 5:00 P.M. with a </span><span>half hour</span><span> meal break. When normal business hours </span><span>are extended</span><span> due to practice needs the Compliance Billing Auditor may </span><span>be requested</span><span> to </span><span>provide</span><span> coverage.</span></span><span> </span></p></div><div><p><span><span> Candidate must </span><span>be located in</span><span> the Eastern</span><span> </span><span>United</span><span> States and be willing to travel as needed.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><b><span>Working Conditions:</span></b><span> </span></p></div><div><p><span><span>Work </span><span>is normally performed</span><span> in </span><span>an</span><span> </span><span>office setting and requires prolonged sitting.</span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><b><span>Physical Demands:</span></b><span> </span></p></div><div><p><span><span>Physical requirements needed to perform the job are eye-hand coordination and manual dexterity sufficient to </span><span>operate</span><span> a keyboard, photocopier, telephone, </span><span>calculator,</span><span> and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate </span><span>appropriate documents</span><span>.</span></span><span> </span></p></div><div><p><span><span> </span></span><span> </span></p></div><div><p><span> </span></p></div><div><p><b><span>Position Reports to:</span></b><span> </span></p></div><div><p><span><span>Compliance Director, </span><span>USUP</span></span><span> </span></p></div><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><b><u>What We are Offer You</u></b></p><p>At U.S. Urology Partners, we are guided by four core values. Every associate living the core values makes our company an amazing place to work. Here “Every Family Matters”</p><p></p><h1><span class="emphasis-3"><b>Compassion</b></span></h1><p>Make Someone’s Day</p><h1><span class="emphasis-3"><b>Collaboration</b></span></h1><p>Achieve Possibilities Together</p><h1><span class="emphasis-3"><b>Respect</b></span></h1><p>Treat people with dignity</p><h1><span class="emphasis-3"><b>Accountability</b></span></h1><p>Do the right thing</p><p></p><p>Beyond competitive compensation, our well-rounded benefits package includes a range of comprehensive medical, dental and vision plans, HSA / FSA, 401(k) matching, an Employee Assistance Program (EAP) and more.</p><p></p><p><b><u>About US Urology Partners</u></b></p><p>U.S. Urology Partners is one of the nation’s largest independent providers of urology and related specialty services, including general urology, surgical procedures, advanced cancer treatment, and other ancillary services. <span>Through Central Ohio Urology Group, Associated Medical Professionals of NY, Urology of Indiana, and Florida Urology Center, the U.S. Urology Partners clinical network now consists of more than 50 offices throughout the East Coast and Midwest, including a state-of-the-art, urology-specific ambulatory surgery center that is one of the first in the country to offer robotic surgery.</span> <span>U.S. Urology Partners was formed to support urology practices through an experienced team of healthcare executives and resources, while serving as a platform upon which NMS Capital is building a leading provider of urological services through an acquisition strategy.</span></p><p></p><p></p><p></p><p></p><p></p><p style="text-align:left"><i>U.S. Urology Partners is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. </i></p>