[Hiring] Ophthalmic Compliance Auditor @VMG HOLDINGS LLC

Role Description

VMG Health is seeking an experienced Ophthalmic Compliance Auditor to join its Coding Audit and Compliance (CAC) team. The Ophthalmic Compliance Auditor will provide auditing, compliance, education, and consulting services to a broad range of healthcare clients, including:

• Single-specialty and multispecialty physician practices
• Hospitals
• Health systems
• Academic medical centers
• Law firms
• Private equity organizations

Responsibilities include conducting documentation and coding reviews, regulatory research, and provider education. This role requires strong analytical and critical-thinking skills, deep knowledge of healthcare regulatory requirements, and the ability to effectively communicate audit findings to providers, operational leaders, attorneys, and executive stakeholders.

The Ophthalmic Compliance Auditor will serve as a trusted resource to clients and internal team members, providing subject matter expertise in coding and documentation. Responsibilities include:

• Conducting documentation audits
• Delivering provider education
• Supporting due diligence and compliance engagements

Qualifications

• A minimum of 5 - 10 years of hands-on experience in a practice setting, having served as a skilled technician, scribe, or clinic manager
• A minimum of 3 years of healthcare auditing, documentation review, compliance, or regulatory experience
• Experience auditing professional coding within Ophthalmology and/or across multiple specialties and service settings
• Experience analyzing payer policies, regulatory guidance, and reimbursement requirements
• Experience presenting written reports to providers, executives, and/or compliance leadership
• Experience working independently in a consulting or client-service environment preferred

Requirements

• Strong knowledge of CPT, HCPCS, ICD-10 and Ophthalmology / Optometry-related codes and related CMS guidelines
• A thorough understanding and adherence to HIPAA regulations
• Familiarity with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing 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
• Strong written communication skills, including audit report writing and executive-level communications
• Strong organization, communication, analytical, problem-solving, and time management skills
• Ability to effectively facilitate provider education
• Ability to identify trends, interpret data, and develop practical, risk-based recommendations
• Demonstrated professionalism and executive presence when interacting with clients and stakeholders
• A flexible, collaborative approach to managing variable daily tasks and customer types
• A dedication to high-quality, detail-oriented work
• Self-directed and motivated, with the ability to work independently

Benefits

• JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired
• Must be willing to achieve coding certification/s; COE is highly beneficial
• Some travel required

Certifications

• Required: JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired
• Preferred: CPMA, CHC, CPCO, CRC, RHIA, RHIT, COC