Compliance Auditor -Physician

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.

Bachelor's Degree required. Master's Degree preferred. Minimum three years of experience in auditing within healthcare, compliance, regulatory oversight agency, quality management, quality assurance or business analysis.

• 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.
• Demonstrates diplomacy, tact, a professional demeanor and an ability to relate to people of diverse demographic backgrounds.
• Ability to work independently and collaboratively with others.
• 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.
• Demonstrate problem solving and reasoning skills; analyze and synthesize data.
• 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.

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