Shared Services:

Compliance- (Full-Time, Day Shift) -

Job Summary:

The Compliance Auditor-Physician monitors and audits established mechanisms and controls to ensure compliance with regulations. Audits the activities of various departments for compliance with plans, policies and procedures prescribed by management. Prepares and submits reports on the results of audits, recommending improvements in policies and procedures. Cooperates with outside auditors in any undertaking that may expedite their work. Performs other duties as needed. Conducts full range of physician-based audits/projects and develops partnerships with internal and external customers. Performs other duties as needed.

Education and Experience:

Bachelor's Degree in related field required. Experience may be considered in lieu of degree. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis required.

Knowledge and Skills:

Experience with Physician-based audits/projects required. Able to read; write legibly; speak in English with professional quality; use computer and software programs necessary to the position, e.g., Word, Excel, Power Point, Access. Able to prepare and deliver verbal and written presentations. Knowledge of compliance issues related to CMS and OIG pronouncements. Highly functional and well-demonstrated process skills. Demonstrated flexibility in project and initiative management, able to complete work with constantly moving deadlines and multiple priorities. Excellent verbal, written, and interpersonal skills required. Demonstrates diplomacy, tact, a professional demeanor and an ability to relate to people of diverse demographic backgrounds. Ability to work independently. Committed to continuous quality improvement in systems, processes and performance; consistently exercises a learning attitude and approach to all duties; Work calmly and respond courteously when under pressure; team oriented. Able to avoid conflicts of interest and always maintain confidentiality. Able to demonstrate problem solving and reasoning skills. Able to analyze and synthesize data. Able to work independently and collaboratively with others. Able to maintain current knowledge of rapidly changing coding rules and changing Medicare and Medi-Cal regulations through independent research and continuing education. Able to handle pressure, deadlines and interruptions. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications:

Minimum one of the following certifications required: CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician-based).