Responsible for performing independent quality and compliance reviews of coding, documentation, utilization and billing practices. Planning and performing compliance audits of moderate difficulty and complexity with minimal supervision.
Role Specific Responsibilities
o Participates in development of the Annual Work Plan.
o Provides support for answering the Compliance Helpline.
o Researches regulatory issues.
o Performs audits and investigations with focus on detecting and preventing fraud and abuse.
o Develops project-specific audit plans.
o Reports on audit findings, provides related education, and supports the development of corrective actions for deficiencies.