Compliance Auditor

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

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 I 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.

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.

THIS IS NOT AN H1- B OPPORTUNITY

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 (ucop.edu) covering all employees. To be compliant with the policy, employees must submit proof of vaccination or a University-approved exception or deferral.

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