[Hiring] System Compliance Auditor @University of Vermont Health Network

Role Description

The System Compliance Auditor identifies and assesses risks in the organization’s documentation, coding, and billing processes and assists in the avoidance of potential fines and penalties from government agencies. They serve as a resource for the UVM Health to ensure the System is compliant with applicable state and federal regulations as they relate to documentation, coding, reporting, and billing of health care services.

• Develops and provides orientation training for new providers.
• Performs annual audits of provider billing.
• Provides ongoing education to providers and employees, especially those involved in the preparation and/or submission of professional bills to federal payers.
• Reports audit findings to billing providers, administrative and clinical leaders, and non-clinical staff.
• Makes recommendations based on audit findings.
• Works closely with several other departments including:
• Professional Revenue Department
• Patient Financial Services
• Coding Education team
• Health Information Management (HIM)
• Revenue Integrity
• Management and physician leaders among various Medical Group clinics
• Identifies billing-related risk areas and conducts audits of such risk areas.
• Recommends measures to reduce risk and promote compliance with applicable rules.
• Assists with the development of the annual Compliance Audit Work Plan.
• Ensures that organizational policies and audit standards conform to requirements.
• Keeps current on all applicable state and federal regulations pertaining to documentation, coding, and billing.

Qualifications

• Bachelor's degree in business, health care operations, or a clinical field required.
• Substantial work-related experience as an auditor, along with academic credentials, may serve as a substitute.
• Master's degree in business or health care related field preferred.
• Must possess certification issued by the American Academy of Professional Coders (AAPC).
• Certification as CPC-E/M Auditor preferred.

Requirements

• Must possess five years of work-related experience in coding and billing for professional services.
• One year of auditing experience required.