VCU Health System’s Corporate Compliance department is seeking a full time Compliance Auditor Senior to review complex audits, perform quality assurance reviews, act as a peer mentor, and assist management with onboarding process of new auditors. Supports the audit supervisor with the development and maintenance of the quarterly audit work plan and audit workflow processes. Recommends changes to improve business operations by using professional judgement and knowledge of best practices. Contributes to special projects, as applicable. Performs documentation/chart audits on inpatient and outpatient records, provides analysis of the records (provider and facility) reviewed, education and other assistance, as needed. Audits VCUHS coding and billing (DRG, CPT, ICD-9/10) based on a review of medical record documentation and/or billing claim data.
- Utilizes high degree of self-direction by analyzing an issue, developing a plan to resolve, and implementing the resolution.
- Takes initiatives and performs tasks with minimal supervision.
- One of the following AAPC’s current certifications required:
- Certified Professional Coder (CPC)
- Certified Professional Coder-Hospital (CPC-H)
- Certified Professional Coder-Payer (CPC-P)
- CPMA Certified Professional Medical Auditor (CPMA)
- One of the following AHIMA’S current certifications required:
- Certified Coding Associate (CCA)
- Certified Coding Specialist (CCS)
- Certified Coding Specialist-Physician Based (CCS-P)
- Other related current coding certification required
- Previous experience with personal computers and software applications to include Microsoft Word, Excel, PowerPoint, and data collection tools
- Previous analytical experience
- Minimum of five (5) years of progressively responsible experience in a healthcare environment to include, but not limited to, the following:
- Working with electronic health records to analyze and interpret clinical documentation for compliance purposes
- Auditing and investigating medical records for compliance
- Understanding and identifying diagnostic and procedural codes for clinical services rendered
- Seven (7) years of progressive coding and/or coding review experience in CPT, ICD-10; HCPCS coding
- Five (5) years previous hospital/physician related work experience in training individuals or groups
- Bachelor’s Degree in Business, Finance, Allied Health, or other health-related field from an accredited program
Instructions for Resume Submission:
Please apply online at www.vcuhealth.org/careers