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Compliance Auditor Job in Richmond, Virginia

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Job Title: Compliance Auditor

Employer:VCU Health System
Required Certifications:CCS or CCS-P,CPMA,CPC-P,CPC-H,CPC,CCA
Location: Richmond 23298, VA, US
Date Posted:10/8/2019

VCU Health System's Corporate Compliance is seeking a full time Compliance Auditor to perform documentation/chart audits on inpatient and outpatient records, and to provide analysis of the records (provider and facility) reviewed, education and other assistance as needed. Audits to include VCUHS coding and billing (DRG, CPT, ICD-9/10) based on a review of medical record documentation and/or billing claim data.


·       Conducts audits of hospital and/or physician claims to ensure compliance with all applicable federal, state, local and payor specific requirements. Expectation is the completion of two risk-based audits per month.

·       Facilitates and improves clinicians’, administrators' and other appropriate individuals' understanding of payor and regulatory requirements by providing feedback related to documentation and billing information.

·       Works with the Compliance Educator to provide educational topics, including identifying risk-areas and changes in documentation/coding requirements; reviewing materials for Compliance Department’s approval; and co-teaching of general compliance education sessions.

·       Maintains a working knowledge of relevant compliance issues, laws and regulations through periodicals, seminars, training programs, and peer contact.

·       Assists management of departments with identified non-compliant issues in developing Corrective Action.

·       Plans to correct potential weakness and assure ongoing compliance.



·       Bachelor’s Degree in Business or Healthcare related field

·       One of the following AAPC's or AHIMA'S current certifications required*:

Certified Professional Coder (CPC)

Certified Professional Coder-Hospital (CPC-H)

Certified Professional Coder-Payer (CPC-P)

CPMA Certified Professional Medical Auditor (CPMA)

Certified Coding Associate (CCA)

Certified Coding Specialist (CCS)

Certified Coding Specialist-Physician Based (CCS-P)


*Other related current coding certification required*

**or successfully obtained within six (6) months from date of hire

·       Minimum of three (3) years of progressively responsible experience in hospital/physician coding and documentation reviews; healthcare compliance and working with electronic health records

·       Previous experience with personal computers and software applications to include Microsoft Word, Excel and PowerPoint


·       Two (2) years of auditing work experience

At VCU Health System, our most important assets are not bricks and mortar; they are our team members … all 13,000+ of them. Our workforce is diverse, dedicated and talented. Our team members continue to earn local, regional and national awards and accolades, which is an indicator that they are happy and feel supported working here. And our culture of STAR Service focuses on our common purpose – “Our Caring Service Begins With Me.” – in the provision of the highest level of customer service, which encourages diversity and inclusion.

If you have been looking to take your career to the next level, we have been looking for you. We offer more than 400 work/life benefits including competitive pay, generous benefits, flexible work options, prepaid tuition, on-site child and elder care and much, much more.

EOE M/F/Vets/Disabled. VCUHS appreciates diversity and encourages women, minorities, veterans and persons with disabilities to apply.


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