Compliance Specialist

About This Role

This Compliance Specialist will review and audit faculty and physician documentation for compliance, utilizing coding knowledge to abstract, record, and audit medical record data. The role provides essential support related to documentation, regulatory education, and continuous auditing to ensure adherence to guidelines.

Responsibilities

• Locate and compile required medical documentation from various sources, ensuring completeness and accuracy for pre-audit meetings
• Audit and review UBs and 1500s against provider and facility documentation to ensure compliance with University, state, and federal guidelines
• Reconcile clinic or provider visits and report missing, incomplete, or inconsistent documentation to the assigned Compliance Officer
• Interact with and provide auditing feedback to providers, hospital staff, and clinic managers on billing-related issues
• Research, maintain current knowledge, and interpret state and federal regulations regarding healthcare payments to audit claims correctly

Requirements

• Basic knowledge of clinical documentation requirements related to regulatory and reimbursement rules
• Knowledge of the Medicare system
• Proficiency with computer software such as Microsoft Word and Excel
• Demonstrated human relations and effective communication skills

Qualifications

• Bachelor’s degree in Health Care Administration, Business Administration or a related field or equivalency
• 2 years working experience with one of those years working in a compliance office

Nice to Have

• Experience with University of Utah computer systems such as: Powerchart, Allegra, IDX, IDXRAD, Corporate Radar, Cognos, EPIC and ORMIS

Skills

* Required skills

Certifications