Unified Physician Management

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Compliance Auditor

at Unified Physician Management

Posted: 7/8/2020
Job Status: Full Time
Job Reference #: 1038

Job Description

Performs comprehensive audit of care center locations/divisions.  Reviews patient charts for accurate documentation of medical codes for diagnoses, procedures, and services performed by OB/GYN physicians and other qualified healthcare providers. Evaluates key administrative, operational, and compliance requirements. Communicates with providers verbally and in written report format. Informs leadership and the Executive team of audit findings, potential deficiencies, and assists in the development of corrective action plans. Communicates with upline management of identified trends and areas of risk. Provides recommendations for improvement in the patient experience, clinical outcomes, and mitigation of risk to the Company.

 

ATTRIBUTES/QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each primary responsibility/job function satisfactorily. Knowledge of physician group practice, standards of medical record maintenance and documentation, medical coding, reimbursement concepts, and local/state/federal regulatory requirements.  Demonstrated organizational skills, ability to meet deadlines, and work independently in a remote environment.  Excellent verbal/written communication and presentation skills required. Minimal travel required.

Skill / Requirements

REQUIRED EDUCATION/EXPERIENCE:

Certified Professional Coder (CPC) credentialed with a minimum of three years of medical coding experience in area of specialty.  All auditors must maintain a valid and current coding certification. OB/GYN experience preferred.  Experience in surgical coding a plus. Recommend having at minimum background in the healthcare industry.

 

PRIMARY RESPONSIBILITIES/JOB FUNCTIONS:  

  • Abides by and demonstrates the Company Mission, Vision, and Values through both behavior and job performance on a day-to-day basis.
  • Conducts complete and timely comprehensive audits as assigned.
  • Performs pre and post billing patient 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.
  • Keeps abreast of all Company policies/procedures, local/state/federal laws/regulations, and serves as a resource to care center locations/divisions in these areas.
  • 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 and/or performance improvement plans.
  • Prepares accurate and timely written executive summary of findings report.
  • Provides feedback to the Compliance Department and Company departments regarding recommended revisions or updates to Company policies.
  • Adheres to all Company 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.

Important Notes

We offer a competitive salary and an excellent benefit package that includes health/dental/life/STD/LTD/vision insurance, paid time off, and 401(k) plan.    This company is a drug-free workplace and an Equal Employment Opportunity employer.

Application Instructions

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