Unified Physician Management
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Compliance Auditor- Texas
at Unified Physician Management
The Compliance Auditor performs comprehensive audits of care center locations/divisions. The Compliance Auditor reviews patient charts for accurate documentation of medical codes for diagnoses, procedures, and services performed by OB/GYN physicians and other qualified healthcare providers. This individual inspects personnel files and evaluates key administrative and compliance requirements, as well as informs the leadership and Executive team of audit findings, potential deficiencies, and assists in the development of corrective action plans. The Compliance Auditor communicates with up-line management of identified trends and areas of risk and provides recommendations for improvement in the patient experience, clinical outcomes, and mitigation of risk to the Company.
Duties include but are not limited to:
- Abides by and demonstrates the Company Mission, Vision, and Values through both behavior and job performance on a day-to-day basis.
- Conducts 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.
- Evaluates office management of human resources and adherence to Company policies through review of personnel files and interview.
- Keeps abreast of all Company policies/procedures, local/state/federal laws/regulations, and serves as 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’s policies and procedure, 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.
- Certified Professional Coder (CPC) credentialed with a minimum of three years of medical coding experience in area of specialty.
- All coders providing services are required to maintain a valid and current certification.
- OB/GYN experience preferred.
- Medical insurance authorizations, eligibility, claims/denials, medical electronic billing claim and reimbursement submission experience.
- Healthcare industry experience required
- Knowledge of physician group practice, medical record standards and documentation, medical coding, reimbursement concepts, and local/state/federal regulatory requirements.
- Demonstrated leadership skills and ability to design and implement effective change programs.
- Excellent verbal/written communication and presentation skills required. Minimal travel required.