Coding & Compliance Auditor

🔥 25 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 10%

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VMG Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1995

🏥 Healthcare

💼 Consulting

☁️ SaaS

💰 Private equity on 2020-04

Healthcare • Consulting • SaaS

VMG Health is a healthcare-focused consulting firm with three decades of experience that provides advisory, operational, compliance, valuation, and transaction services to healthcare organizations. The firm offers M&A and transaction advisory, valuation advisory, coding audit and compliance, strategy and operational performance consulting, physician enterprise solutions, litigation and dispute resolution support, and specialized expertise in ophthalmology and eyecare. VMG also develops software and analytics products (e. g. , Compliance Risk Analyzer®, FMV-MD®, Intellimarker®) and membership programs to support client performance. The company serves clients across all 50 states, employs 300+ professionals, and recently acquired Community Link Consulting.

📋 Description

• Provide auditing, compliance, education, and consulting services to healthcare clients • Conduct documentation and coding reviews, regulatory research, and provider education • Work as part of an audit team to complete client projects within productivity, quality, and deadline standards • Access medical record documentation from client EMR/PM systems • Analyze medical records for chart content and documentation requirements • Use audit reporting tools to document results and prepare reports for quality assurance review and client delivery • Interpret CMS, AMA, OIG, NCCI, and payer guidance for audit findings and compliance recommendations • Identify documentation, coding, billing, and risk trends and communicate findings • Prepare and present audit results, executive summaries, and compliance recommendations • Develop audit findings reports and corrective action plans • Conduct education and training sessions for internal team members and clients • Educate providers on documentation and compliance matters • Participate in quality assurance and peer review activities • Assist with audit tools, educational materials, methodologies, and compliance resources • Coordinate and research resources for client projects • Assist leadership with on-time, in-scope, and on-budget project delivery • Support project scope and objective development and stakeholder engagement • Develop and maintain client and stakeholder relationships • Review quality assurance reports and implement corrections • Maintain current knowledge of government regulatory guidance and payer requirements • Maintain awareness of healthcare auditing principles and compliance topics

🎯 Requirements

• Experienced Ophthalmic Compliance Auditor • Minimum of 5–10 years of hands-on experience in a practice setting as a skilled technician, scribe, or clinic manager, or minimum of 3 years of healthcare auditing, documentation review, compliance, or regulatory experience • Experience analyzing payer policies, regulatory guidance, and reimbursement requirements and translating findings into actionable recommendations • Experience presenting written reports to providers, executives, and/or compliance leadership • Experience working independently in a consulting or client-service environment preferred • Strong knowledge of CPT, HCPCS, ICD-10, and Ophthalmology/Optometry-related codes and CMS guidelines • Thorough understanding of and adherence to HIPAA regulations • Familiarity with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing procedures • Specific expertise in ophthalmology highly desirable • Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, and healthcare reimbursement principles • Ability to evaluate complex documentation scenarios and apply nuanced regulatory guidance • Strong written communication skills, including audit report writing, corrective action development, and executive-level communications • Strong organization, communication, analytical, problem-solving, and time management skills • Ability to facilitate provider education • Ability to identify trends, interpret data, and develop practical, risk-based recommendations • Demonstrated professionalism and executive presence with clients and stakeholders • Willingness to work with team members to achieve consensus on billing and coding issues • Flexible, collaborative approach to variable tasks and customer types • High-quality, detail-oriented work • Self-directed and motivated; able to work independently, prioritize responsibilities, and maintain productivity remotely • Tech and internet savvy; experience with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) • JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired • Must be willing to achieve coding certification(s) • COE highly beneficial • Preferred certifications: CPMA, CHC, CPCO, CRC, RHIA, RHIT, COC

🏖️ Benefits

• Fully remote work arrangement • Some travel required