POSITION OVERVIEW:

The Compliance Auditor supports the Orthopedic Care Partners (OCP) Compliance Program by conducting structured audits and monitoring activities to assess compliance with regulatory standards, payer policies, and OCP guidelines. The Auditor performs coding and documentation reviews for physicians and advanced practice providers (APPs), as well as other compliance-related audits, as specified in OCP’s annual auditing and monitoring plan and as requested by the CCO.

ESSENTIAL FUNCTIONS INCLUDE, BUT ARE NOT LIMITED TO:

• Perform compliance-related audits identified through OCP’s annual auditing and monitoring plan or at the direction of the Chief Compliance Officer.
• Identify potential compliance risks, documentation deficiencies, or coding inaccuracies.
• Document audit methodologies, results, root causes, and corrective action recommendations and plans in the Healthicity compliance management system.
• Present audit results to stakeholders as directed by the Chief Compliance Officer.
• Develop summary reports that reflect audit activity, trends, and compliance risk areas.
• Provide targeted education to physicians, providers, and staff regarding deficiencies identified during audits.
• Support the development of educational materials or focused training related to audit findings.
• Work collaboratively with operational leadership to ensure corrective actions are implemented.
• Conduct follow-up reviews and re-audits when required to evaluate whether corrective actions are implemented and effective.
• Monitor improvement trends and identify areas that may require additional oversight or education.
• Escalate unresolved compliance concerns to the Chief Compliance Officer.
• Demonstrate a high level of proficiency in records management and reporting within the Healthicity compliance platform.
• Performs additional duties necessary to support the compliance function and under the direction of the CCO.

MINIMUM REQUIREMENTS / QUALIFICATIONS

• Professional certification, such as CPC required. (CPMA certification preferred) 
• Experience auditing physician or advanced practice provider documentation and coding.
• Bachelor’s degree in healthcare administration, health information management, nursing, compliance, or related field (or equivalent experience).
• Minimum 3 years of experience in healthcare auditing, coding, compliance, or revenue cycle within a physician practice or healthcare organization.
• Working knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
• Understanding of medical documentation standards and payer billing requirements.

CORE COMPETENCIES:

• Medical coding and documentation analysis
• Audit methodology and compliance monitoring
• Data analysis and reporting
• Professional communication and presentation skills
• Ability to educate providers and staff on documentation and coding requirements
• Strong attention to detail and organizational skills

PHYSICAL REQUIREMENTS

This is a remote position. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
• While performing the duties of this job, the employee is regularly required to talk and hear.
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to: remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.).
• Frequently required to stand, walk, sit, use hands to feel, and reach with hand and arms
• Occasionally lift and/or move up to 20-25 pounds.
• Fine hand manipulation (keyboarding).
• Travel to existing or new OCP locations may be required.