May 18, 2023

Compliance Auditor

  • UC Davis
  • Sacramento, CA, USA
Full Time Other

Job Description

Department Description

The UCDHS Executive Compliance Office is a comprehensive approach to promoting ethical and proper behavior in all matters related to UCDHS business operations and to establish effective controls that promote adherence to applicable laws, regulations, rules, guidelines, requirements, procedures, and directives regarding Federal, State, and Private health matters. The compliance coding quality program (CQA) facilitates enforcement with University policy with the goal of minimizing risks associated with documentation and billing, as one method of preventing and detecting inappropriate, improper, and fraudulent billing practices. MGR234

The Coding Quality Assessment (CQA) program reviews the accuracy of the coding activities and physician documentation throughout UCDHS. The position is responsible for performing quality assessments, which incorporates reviews of the Patient Record Abstractors (PRA) and Physician Documentation Reviews (PDR) as they relate to the accuracy of coding and the quality of the documentation.


Job Summary


The position serves as a physician/staff advocate, working with individuals and departments on billing/coding and documentation reviews, providing formal/informal physician/staff training such as one-on-one to improve physician documentation proficiency using the EMR charting tools, promoting compliance with billing and coding requirements for optimal reimbursement and participating in education development and maintenance.

The Compliance program is directed by the Chief Compliance Officer and Compliance Manager, which are responsible for the operations of the program. This position reports to the Compliance Manager and is able to work independently and effectively with general supervision.


Required Education/Experience

  • Must possess and maintain certification as a Coding Specialist through American Health Information Association (AHIMA CCS-P) or American Association of Professional Coders (AAPC CPC) or Equivalent relevant and extensive experience in coding and auditing will be considered.
  • Extensive experience in CPT and ICD-9/10-CM coding abstracting in a clinical setting (hospital, ED, clinic, etc.) experience using coding and principals and conventions in multi-specialty areas.
  • Experience reading state and federal mandates with ability to comprehend and interpret applicable documentation and coding compliance.
  • Strong knowledge of healthcare documentation requirements, coding regulatory requirements, and healthcare billing Comprehensive knowledge in auditing coding accuracy and conducting physician documentation reviews.
  • Demonstrated skills to review data and audit findings to identify coding trends and risk areas.
  • Extensive knowledge in disease processes and anatomy and physiology necessary for assigning accurate codes.
  • Comprehensive knowledge of medical abbreviations and symbols, medical terminology, clinical documentation, ancillary test results and policies and procedures.
  • Knowledge of CMS legislation in relationship to Medicare coding and documentation compliance, National Correct coding Initiative, and fraud and abuse issues.
  • Strong written, verbal and presentation skills to share audit findings, risk areas, documentation and coding issues.
  • Demonstrated strong project management skills.
  • Demonstrated strong analytical skills with the ability to influence and change behaviors when applicable.


Preferred Education/Experience

  • Experience working in a Compliance capacity.
  • Experience coordinating and enforce a coding ethics program with annual review of fraud and abuse acknowledgment statements, ethical standards of coding, and availability of reporting practices to report suspected fraud and abuse.
  • Experience with key UCDHS systems; EMR, CCE, RCE, Signature, lnvision, and Quantim. Experience with MS Word, Excel, PowerPoint and Access software.
  • Experience with Snagit and other HTML-authoring software.
  • Demonstrated systems knowledge and in-depth understanding of clinical quality and performance improvement processes.
  • Comprehensive knowledge of payer plan requirements, managed care environment, authorization processes, appointment scheduling, registration, and reimbursement contracts.
  • Working knowledge of utilization review process, physician workflows including ambulatory care, admitting, rounding, transfer and discharge procedures, and their operational impact of the institution.
  • Knowledge of UHDDS, OSHPD, Title 22, and the Joint Commission documentation guidelines sufficient to assess screening procedures and ensure coding compliance.


Final Filing Date                    

June 2, 2023 at 11:59p

Interviews may occur at any time.

Salary Range                      

$74,600 - $141,000. Salary Grade 23.

Salary Frequency                 


Appointment Type                 


Percentage of Time               


Shift Hour                              

Mon - Fri



Sherman Way Building (HSP056)



Hybrid/Remote work location is approved.

Union Representation            


Benefits Eligible                     



We offer exceptional employment benefits including medical, dental, and vision plans, generous paid vacations and holidays, excellent retirement savings and investment plans, continuing education, and reduced fee and scholarship programs.


Special Requirements

This position may be subject to a criminal background investigation, drug screen, Live Scan fingerprinting, medical evaluation clearance, and functional capacity assessment.

The University of California has implemented a SARS-CoV-2 (COVID-19) Vaccination Program SARS-CoV-2 Vaccination Policy ( covering all employees. To be compliant with the policy, employees must submit proof of vaccination or a University-approved exception or deferral.

Diversity, Equity, Inclusion and Belonging
At UC Davis, were solving lifes most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we dont just maintain - we improve.

We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds, and you belong here.

As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected.

The University of California is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.

Required Experience Level

Intermediate Level