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Compliance Auditor
VCU Health

Location: Richmond, Virginia
Work Setting: Hospital
Job Function:
Job Type:


VCU Health System’s Corporate Compliance is seeking a full time Compliance Auditor to perform documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility) reviewed, education and other assistance as needed. Audits to include VCUHS coding and billing (DRG, CPT, ICD-9/10) based on a review of medical record documentation and/or billing claim data.

Job Description

Conducts audits of hospital and/or physician claims to ensure compliance with all applicable federal, state, local and payor specific requirements. Expectation is the completion of two risk-based audits per month.

Facilitates and improves clinicians’, administrators’ and other appropriate individuals’ understanding of payor and regulatory requirements by providing feedback related to documentation and billing information.

Works with the Compliance Educator to provide educational topics, including identifying risk-areas and changes in documentation/coding requirements; reviewing materials for Compliance Department’s approval; and co-teaching of general compliance education sessions.

Maintains a working knowledge of relevant compliance issues, laws and regulations through periodicals, seminars, training programs, and peer contact.

Assists management of departments with identified non-compliant issues in developing Corrective Action.

Plans to correct potential weakness and assure ongoing compliance.

Required Qualifications

One of the following AAPC’s or AHIMA’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)

Certified Coding Associate (CCA)

Certified Coding Specialist (CCS)

Certified Coding Specialist-Physician Based (CCS-P)

*Other related current coding certification required*

**or successfully obtained within six (6) months from date of hire

Minimum of three (3) years of progressively responsible experience in hospital/physician coding and documentation reviews; healthcare compliance and working with electronic health records

Previous experience with personal computers and software applications to include Microsoft Word, Excel and PowerPoint

Preferred Qualifications

Two (2) years of auditing work experience

Education Qualifications

Bachelor’s Degree in Business or Healthcare related field

Instructions for Resume Submission

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Posted: September 20, 2019 at 9:57 AM
Post ID: 42994

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