Documentation Auditor (Corporate Compliance)

Performs documentation audits of inpatient and outpatient records, provides analysis of the records reviewed, education and other assistance as needed. Audits include review of claims data and medical record documentation for professional fee (e.g., Medicare Part B) services. Verifies that billing reflects the care documented and that all applicable regulatory requirements were met. Identifies areas of potential exposure and/or revenue loss based on CMS regulations. Auditor must be proficient with CPT® procedural coding, ICD-10-CM diagnosis coding, Medicare teaching physician regulations and all other applicable CMS requirements. Multi-specialty knowledge and experience, including Evaluation and Management, is required. This position reports to the Associate Director of Documentation Compliance and Internal Audit, under the direction of the Chief Compliance Officer of FPI.

Essential Functions

• Conducts audits of physician/professional fee claims to ensure compliance with all applicable federal, state, local and payor specific requirements.
• Ensures that appropriate procedural and diagnostic codes were submitted on CMS-1500 forms, based on providers’ documentation in the medical record.
• Audits medical records and accurately and thoroughly documents findings within the auditing software. . Prepares an executive summary of each audit, including observations and recommendations for corrective actions.
• Monitors accuracy of own audits; maintains accurate records; recognizes and corrects errors and ensures quality of work.
• Independently presents compliance audits to department leadership (Chairs, physicians, Administrators, compliance liaisons) and coding staff.
• Increases providers’ and employees’ awareness and understanding of regulatory requirements by providing feedback and education related to audits

Note: The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job.  Incumbents perform other related duties as assigned.  Specific duties and responsibilities may vary based upon departmental needs.

Education And/Or Experience

• Three (3) to five (5) years of progressively responsible experience in multi-specialty physician/professional fee coding and documentation reviews.
• Strong background in Evaluation and Management coding, including a thorough understanding of the 2021/2023 CPT® guideline changes.
• Two (2) years of physician/professional fee auditing experience and/or two (2) years of healthcare compliance experience is preferred.
• Must have Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) credential.
• Must have Certified Professional Medical Auditor (CPMA) credential (or ability to obtain within 6 months).
• Bachelor’s degree in healthcare related field is preferred.
• Experience in an academic medical center (AMC) is preferred.

Total Rewards
The referenced base salary range represents the low and high end of University of Maryland’s Faculty Physician’s Inc. salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographic location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/training and other qualifications.  University of Maryland Faculty Physician’s Inc. offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://www.umfpi.org/jobs/summary-employee-benefits