Details
Posted: 24-Apr-22
Location: Irvine, California
Type: Full-time
Salary: Open

University of California Irvine
Compliance Audit Officer
Updated: May 4, 2022
Location: UC Irvine Campus
Job Type:
Department: SOM-Compliance
Job Opening ID: 34778
Reports To: Chief Compliance and Privacy Officer
Working Title: Compliance Audit Officer - Remote/Hybrid
Department: SOM-Compliance
Bargaining Unit: 99
FLSA: Exempt
Payroll Job Code: 000679
Job Location: UCI Campus- Irvine
Percent of Time: 100%
Work Schedule: 8-5, M-F
Employee Class: Career
Position Summary:
The UCI Health Compliance Program is responsible for implementation of an effective compliance program consistent with the U.S. Federal Sentencing Guidelines and guidance of the HHS Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across the UCI healthcare enterprise, which includes a leading academic medical center, outpatient clinics, professional services, and clinical schools. The Program develops, implements, and enforces University policy related to UCI clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.
Under the direction of the Chief Compliance and Privacy Officer, the Compliance Audit Officer (CAO) is responsible for directing, developing, and implementing the UCI Health Compliance Audit program. The CAO oversees the billing and coding audit function within the compliance department, supervises all compliance auditors and leads compliance billing and coding investigations. In consultation with the Chief Compliance and Privacy Officer, identifies billing and coding compliance risks, interprets relevant laws, statutes and policies governing compliance issues. The CAO coordinates and leads special projects and policy redesigns to accomplish compliance with applicable laws and regulations. This position provides oversight of professional fee audits, research billing audits, and other audits and assures that operations leverage leading practice industry standards and meets all regulatory requirements. The CAO works in consultation with providers and other key stakeholders to improve data management, documentation processes and health system policies.
Compensation Range:
Commensurate with experience.
Department Website:
Required:
Seven (7+) or more years of progressively responsible healthcare compliance experience with five (5+) or more years of manager level experience and direct supervision of team members in healthcare compliance or closely related area. Experience with and advanced knowledge of current health care regulations, state medical and public agency privacy laws, and medical center procedures. Expert knowledge of clinical and operational issues regarding billing and coding compliance and assessing risk.Bachelor's degree in business, healthcare administration or related area; and/or equivalent combination of experience and training.
Certified Professional Coder Certified Professional Medical Auditor Certified Evaluation and Management Coder Certified in Healthcare ComplianceBroad and thorough knowledge of the compliance audit profession, theories and systems of internal control, and professional auditing standards. Experience developing operating procedures and processes. Effective communication and presentation skills, both verbally and in writing, to convey audit findings and results in a clear and concise manner. Strong interpersonal skills to work independently with all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions. Ability to demonstrate professional judgment in the supervision of audit projects. Topics may include sensitive and / or confidential matters. Demonstrated management skills including project-level budgeting, project management, and policy implementation. Experience and demonstrated ability to consistently interact and negotiate with all members of the organization in ways that enhance understanding, respect, cooperation and problem-solving. Demonstrated knowledge, skills, or ability to work independently, manage multiple activities simultaneously, solve problems, and set priorities for self and others. Demonstrated ability to: (a) Identify key issues critical to the success of a desired product/outcome; (b) Quickly research and analyze data; (c) Integrate essential information; (d) Utilize the analysis to define and test options and alternatives; and (e) Develop recommendations and justification for the most productive course of action. Must be insightful and possess creative skill in reasoning and logic, as well as quantitative analysis. Knowledge of current federal and state billing and coding laws and regulations, including: Medi-Cal, and other third-party payers billing guidelines (professional fee and hospital billing). Working knowledge of medical coding and billing procedures, teaching physician regulations, professional fee billing, and hospital facility billing, including CPT coding, ICD 9 and 10, modifiers, DRG's, APCs
Special Conditions Required:
Must pass a background check.
Conditions of Employment
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:
-
Background Check and Live Scan
-
Legal Right to work in the United States
-
Vaccination Policies
-
Smoking and Tobacco Policy
-
Drug Free Environment
The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.
The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the
UC nondiscrimination policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact Human Resources at (949) 824-0500 or
eec@uci.edu Job Opening ID: 34778
Reports To: Chief Compliance and Privacy Officer
Working Title: Compliance Audit Officer - Remote/Hybrid
Department: SOM-Compliance
Bargaining Unit: 99
FLSA: Exempt
Payroll Job Code: 000679
Job Location: UCI Campus- Irvine
Percent of Time: 100%
Work Schedule: 8-5, M-F
Employee Class: Career
Position Summary: The UCI Health Compliance Program is responsible for implementation of an effective compliance program consistent with the U.S. Federal Sentencing Guidelines and guidance of the HHS Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across the UCI healthcare enterprise, which includes a leading academic medical center, outpatient clinics, professional services, and clinical schools. The Program develops, implements, and enforces University policy related to UCI clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services. Under the direction of the Chief Compliance and Privacy Officer, the Compliance Audit Officer (CAO) is responsible for directing, developing, and implementing the UCI Health Compliance Audit program. The CAO oversees the billing and coding audit function within the compliance department, supervises all compliance auditors and leads compliance billing and coding investigations. In consultation with the Chief Compliance and Privacy Officer, identifies billing and coding compliance risks, interprets relevant laws, statutes and policies governing compliance issues. The CAO coordinates and leads special projects and policy redesigns to accomplish compliance with applicable laws and regulations. This position provides oversight of professional fee audits, research billing audits, and other audits and assures that operations leverage leading practice industry standards and meets all regulatory requirements. The CAO works in consultation with providers and other key stakeholders to improve data management, documentation processes and health system policies.
Compensation Range:Commensurate with experience.
Department Website: https://www.ucihealth.org/compliance Required: Seven (7+) or more years of progressively responsible healthcare compliance experience with five (5+) or more years of manager level experience and direct supervision of team members in healthcare compliance or closely related area. Experience with and advanced knowledge of current health care regulations, state medical and public agency privacy laws, and medical center procedures. Expert knowledge of clinical and operational issues regarding billing and coding compliance and assessing risk.Bachelor's degree in business, healthcare administration or related area; and/or equivalent combination of experience and training. Certified Professional Coder Certified Professional Medical Auditor Certified Evaluation and Management Coder Certified in Healthcare ComplianceBroad and thorough knowledge of the compliance audit profession, theories and systems of internal control, and professional auditing standards. Experience developing operating procedures and processes. Effective communication and presentation skills, both verbally and in writing, to convey audit findings and results in a clear and concise manner. Strong interpersonal skills to work independently with all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions. Ability to demonstrate professional judgment in the supervision of audit projects. Topics may include sensitive and / or confidential matters. Demonstrated management skills including project-level budgeting, project management, and policy implementation. Experience and demonstrated ability to consistently interact and negotiate with all members of the organization in ways that enhance understanding, respect, cooperation and problem-solving. Demonstrated knowledge, skills, or ability to work independently, manage multiple activities simultaneously, solve problems, and set priorities for self and others. Demonstrated ability to: (a) Identify key issues critical to the success of a desired product/outcome; (b) Quickly research and analyze data; (c) Integrate essential information; (d) Utilize the analysis to define and test options and alternatives; and (e) Develop recommendations and justification for the most productive course of action. Must be insightful and possess creative skill in reasoning and logic, as well as quantitative analysis. Knowledge of current federal and state billing and coding laws and regulations, including: Medi-Cal, and other third-party payers billing guidelines (professional fee and hospital billing). Working knowledge of medical coding and billing procedures, teaching physician regulations, professional fee billing, and hospital facility billing, including CPT coding, ICD 9 and 10, modifiers, DRG's, APCs Special Conditions Required: Must pass a background check. Conditions of Employment
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:Background Check and Live ScanLegal Right to work in the United StatesVaccination PoliciesSmoking and Tobacco PolicyDrug Free EnvironmentThe following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.California Child Abuse and Neglect Reporting ActE-VerifyPre-Placement Health EvaluationDetails of each policy may be reviewed by visiting the following page - https://hr.uci.edu/new-hire/conditions-of-employment.php
Closing Statement
The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy. We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact Human Resources at (949) 824-0500 or eec@uci.edu
To apply, visit https://careersucirvine.ttcportals.com/jobs/9393940-compliance-audit-officer

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