Compliance Audit Specialist III

Summary

Conduct testing and monitoring activities for the University clinical practice related to compliance with federal and state regulatory requirements for physician/provider documentation and billing. May conduct and/or supervise responses to requests for documentation from external integrity entities and other regulatory bodies. May conduct data analytics to search for outliers that may be indicative of revenue or documentation integrity issues. Draft outcomes, prepare findings and support documentation. May assist program leadership in presenting findings and written communication.

Examples of Work

Job functions are specific duties that would be included in the essential functions of the job description. These functions are not all-inclusive nor do they cover the full extent of the duties performed.

• Conducts confidential investigations pursuant to audit findings, reported concerns, or detected patterns of error.
• Conducts and coordinates responses to requests for documentation from State Medicaid and Florida Medicare Program Integrity programs, other regulatory bodies and Recovery Audit Contractors.
• Conducts follow-up testing to confirm corrective action pursuant to regular audit activity.
• May supervise compliance audit staff in conduct of same activities.
• Conducts research on regulatory history and current status of regulatory requirements. Drafts opinions, in conjunction with the Coordinator for Education, Associate Director and Director and General Counsel on appropriate interpretation of regulations, and assists in drafting process descriptions to promote compliance upon implementation.
• Reads current rules extensively to remain current and inform others, including Local Coverage Determinations, Carrier publications, regulatory communications, and Florida Medicaid programmatic integrity efforts. Assist in supervision of regular audits, as time permits.
• Researches and drafts educational materials for physicians and staff on coding topics.
• May function as auditor-in-charge, leading an audit team on either regular programmatic audits or special investigations.
• Maintains expertise in the design audit trails related to the College Electronic Medical Record, which may include analysis on processes to ensure regulatory compliance, and education to ensure regulatory compliance.

Education and Experience

High School Diploma or equivalent and five years of appropriate experience. Appropriate college course work may substitute at an equivalent rate for the required experience.

Licensure and Certification

Certified Professional Coder (CPC)/ American Academy of Professional Coders or Certified Coding Specialist (CCS-P) (American Health Information Management Association) or Certified Coding Associate (CCA) (American Health Information Management Association) or Certified in Healthcare Compliance (CHC) or Certified in Healthcare Research Compliance (CHRC) or Certified in Healthcare Privacy Compliance (CHPC) or Certified Compliance & Ethics Professional (CCEP) or Certified Compliance & Ethics Professional-International (CCEP-I) is required.

Supervision

May supervise lower level compliance audit specialists and other support staff.

To see common career pathways for each position at the University of Florida please visit the Career Paths section of the UFHR website.