Sr Compliance Auditor

Description

The Sr Billing Compliance Auditor serves as the liaison responsible for monitoring and auditing NCPS coding and documentation functions for professional fee services. Conducts independent ongoing reviews of vendor and provider-coded professional fee services to ensure practices meet federal requirements. Works closely with NCPS to communicate monitoring / auditing results and provide feedback to support necessary actions taken accordingly. Functions as the subject matter expert for professional fee coding and documentation, and partners with NCPS administrators to ensure consistent, compliant, and accurate coding practices.

Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment. Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements. Monitors professional fee vendor‑coding services to ensure alignment with CMS and Florida Medicaid (AHCA) coding, documentation and billing requirements. Verifies that documentation meets regulatory and organizational standards for medical necessity, specificity, and completeness.

Adheres to monitoring and audit plans, including routine, focused, and prospective audits. Collaborates closely with NCPS assigned liaison(s) / administrators to ensure timely and effective communication of findings and recommendations for next steps. Prepares trends, errors rates, and recommendations for correct action. Fosters a collaborative, solutions‑focused relationship with coding and billing vendor(s), ensuring a culture of transparency, continuous quality improvement, and shared commitment to accurate, compliant coding practices.

Analyzes monitoring and auditing data to identify patterns, recurring issues, and opportunities for improvement. Acts as a resource to NCPS administrators regarding coding and documentation processes. Maintains current knowledge of CMS, AMA, and AHCA coding, documentation and billing guidelines. Prepares updates of changes to provide to NCPS administrators. Researches, analyzes and provides guidance on compliance and coding concerns. Maintains open communication with NCPS administrators and Epic team(s) for any changes or updates to the system that can impact or improve activity of auditors and coding, documentation, and billing processes.

• Conducts audits of NCPS professional fee encounters to validate accuracy of CPT, HCPCS, ICD-10-CM, and modifier assignment.
• Serves as the coding, documentation, and billing expert for NCPS, ensuring focused expertise on pediatric, Fl AHCA / Medicaid, and CMS regulatory requirements.
• Monitors professional fee vendor‑coding services to ensure alignment with CMS and Florida Medicaid (AHCA) coding, documentation and billing requirements.
• Verifies that documentation meets regulatory and organizational standards for medical necessity, specificity, and completeness.
• Adheres to monitoring and audit plans, including routine, focused, and prospective audits.
• Collaborates closely with NCPS assigned liaison(s) / administrators to ensure timely and effective communication of findings and recommendations for next steps.
• Prepares trends, errors rates, and recommendations for correct action.
• Fosters a collaborative, solutions‑focused relationship with coding and billing vendor(s), ensuring a culture of transparency, continuous quality improvement, and shared commitment to accurate, compliant coding practices.
• Analyzes monitoring and auditing data to identify patterns, recurring issues, and opportunities for improvement.
• Acts as a resource to NCPS administrators regarding coding and documentation processes.
• Maintains current knowledge of CMS, AMA, and AHCA coding, documentation and billing guidelines. Prepares updates of changes to provide to NCPS administrators.
• Researches, analyzes and provides guidance on compliance and coding concerns.
• Maintains open communication with NCPS administrators and Epic team(s) for any changes or updates to the system that can impact or improve activity of auditors and coding, documentation, and…