Senior Compliance Billing and Coding Auditor

Bilingual Language Preferred: not applicable
Travel: May Require Occasional Local Travel

Compliance / LegalHybrid Remote, Santa Ana, California


Description

About the Job:

As the Senior Compliance Billing and Coding Auditor, you will be the subject matter expert on auditing medical billing and coding for healthcare compliance at Acuity Eye Group. This position will operate with a high degree of independence under the supervision of the Director of Compliance.

Role Responsibilities:

  • Audit Planning: Research applicable documentation and reimbursement regulations to apply in the development of an audit plan for both scheduled and unscheduled audits and investigations.
  • Conducting Audits: Performs documentation and coding audits, reviewing medical records and charges to ensure compliance with CPT coding standards and the Centers for Medicare & Medicaid Services (CMS) conditions of coverage and guidelines.
  • Analysis, Reporting, and Education: Conducts analysis of audit findings to identify trends/problems in billing and documentation. Writes reports explaining the audit process and present findings to leadership. Delivers education and training to providers on audit results and corrective action plans.
  • Investigations and Monitoring: Tracks and maintains monitoring program to identify potential billing and coding issues and conduct investigations as needed.
  • Compliance Program Activities: Participates in compliance program activities, such as assisting with policies and procedures related to billing and coding compliance, risk assessment and compliance workplan development, and presents progress updates to quarterly executive compliance committee meetings.

We value professional development and offer opportunities for continuing education and practical experience for those pursuing certifications.

REQUIRED

  • Bachelor’s Degree in Business Administration, Hospital Administration, Accounting, Nursing, or related discipline.
  • 3-5 years of experience working in revenue cycle at a health system, medical practice or health plan.
  • 1-2 years of medical compliance auditing experience.
  • One or more of the certifications listed below.
    • Certified Professional Coder (CPC),
    • Certified Outpatient Coding (COC),
    • Certified Professional Medical Auditor (CPMA),
    • Certified Ophthalmology Coder (COPC® )
    • American Academy of Ophthalmic Executives® (AAOE®); Ophthalmic Coding Specialist (OCS)

 PREFERRED: AAPC Certified Professional Medical Auditor (CPMA), Certified Ophthalmology Coder (COPC®), Certified Healthcare Compliance (CHC); Experience in Ophthalmology.

About Acuity Eye Group:

Acuity Eye Group is made up of several integrated ophthalmic service clinics, ambulatory surgery centers, and optometry clinics across Southern California with a comprehensive approach to patient care.

Acuity Eye Group has been committed to building a culture of inclusiveness, ensuring our organization reflects the same diversity found in our patient populations. We actively work to recruit diverse team members and foster a supportive, positive environment where every individual feels respected and has an equal opportunity for success regardless of age, race, sex, gender identity, religion, or sexual orientation.