Physician Compliance Auditor & Trainer

Job Description:
Responsibilities SUMMARY STATEMENT: Under the direct supervision of the Physician Compliance Manager, this position is responsible for supporting the work plan and compliance functions of the Division of Physician Compliance of the Office of Compliance Services.
The responsibilities include: Maintains work plan defined auditing & monitoring activity in coordination with the other staff of this division by 1) Conducts research work in preparation for the audit, 2) Review and analyze provider documentation, 3) Prepare reports, 4) Perform necessary post audit training and education, 5) Provide any necessary follow-up reviews and 6) Maintains work documents of activity.
Serves as a resource for the clients of the Office of Compliance Service to answer compliance questions related to billing and coding of professional services across a broad spectrum of medical specialties that have diverse criteria for billing and coding Answers compliance questions from Internal Audit and Audit Advisory Services and assists as necessary in their audit process Provides scheduled and ad hoc training for the client of the Compliance Office.
Conducts and assists with focused reviews as deemed necessary includes assist in determining the scope of the review, the necessary sample size based on the issue in question and the necessary documentation to obtain for the review Conducts and assists with compliance investigations includes providing input in to the scope of the investigation, the necessary documentation to gather, participating in interviews, maintaining appropriate work papers and drafting the investigation report.
Assists the Hospital Compliance Services division of the Compliance Office with the reviews and investigations they conduct as needed Conducts research on and prepares analysis of coding and billing compliance issues.
Prepares guidance materials, monitoring tools and creates resources to assist the Office of Compliance Services and its clients in maintaining an effective Compliance Program Assists with the review and revision of existing compliance policies and procedures as well as drafting new policies and procedures as needed.
Maintains confidentiality of participants involved in investigations, reviews and audits as well as patient information included in such activity.
Other duties as assignedADMINISTRATIVE DUTIES - Conduct Compliance Reviews o Complete compliance reviews within established parameters, initiate, and carry out all assigned reviews according to defined departmental policies and processes.
o Perform independent reviews of various Health System operations and other functions to determine compliance with applicable statutes, laws, rules regulations, and policies.
o Analyze and evaluate the quality and adequacy of medical record documentation by UCLA Health System providers in support of claims submitted to governmental and other third party payers.
o Analyze and assess the existence and quality of medical record documentation in support of claims for teaching physician services o Analyze and evaluate the accuracy and completeness of CPT and ICD-10 coding practices by UCLA Health System providers in support of claims submitted to governmental and other third party payers.
o Analyze and assess the accuracy and completeness of place of service and date of service documentation in the corresponding medical records and claims submitted to governmental and other third party payers.
o Validate payments received for professional services rendered are accurate and consistent with related contractual guidelines and fee schedules of governmental and other third party payers.
o Continually monitor work assignments for proper timing and completion to help ensure the review schedule is maintained.
o Prepare review findings and as necessary explain those findings to the provider and other parties o Conduct focused reviews in a timely manner and with consistently accurate results.
o Assist the Hospital Compliance Services division of the Compliance Office with reviews as needed.
o When appropriate, participate in external audits/reviews by outside regulatory or law enforcement agencies.
Training and Development o Provide compliance training as necessary based on the findings of compliance reviews, goals and objectives may change throughout the year depending upon identified needs therefore flexibility, efficiency, and the ability to work independently are required.
o Provide compliance education and training to UCLA Health System physicians, residents, fellows, nurses and other appropriate personnel for both scheduled and ad hoc requests.
o Provide direct training in support of continued adherence to the UCLA Health System Code of Conduct, Professional Fee Billing Compliance Plan and associated policies and procedures.
o Represent the Compliance Office at Enterprise/Department/Division meetings, outside educational programs and in-service trainings.
o Maintain professional certification e

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