Coding & Compliance Eye Auditor

h3Description /h3pAt VMG Health, we’re more than just a team of experts; we’re trusted partners in the business of healthcare. Backed by a team of over 300 professionals and a history of more than 70,000 engagements since 1995, we bring experience, deep and wide, to every project. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. Our solutions-oriented approach to client needs is bolstered by our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients’ valuation, strategic, and compliance needs.? /ph3Description /h3pAt VMG Health, we’re more than just a team of experts; we’re trusted partners in the business of healthcare. Backed by a team of over 300 professionals and a history of more than 70,000 engagements since 1995, we bring experience, deep and wide, to every project. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. Our solutions-oriented approach to client needs is bolstered by our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients’ valuation, strategic, and compliance needs.? /ph3Position Summary /h3pVMG Health is seeking an experienced Ophthalmic Compliance Auditor to join its Coding Audit and Compliance (CAC) team. The Ophthalmic Compliance Auditor will provide auditing, compliance, education, and consulting services to a broad range of healthcare clients, including single-specialty and multispecialty physician practices, hospitals, health systems, academic medical centers, law firms, and private equity organizations. Responsibilities include conducting documentation and coding reviews, regulatory research, and provider education. This role requires strong analytical and critical-thinking skills, deep knowledge of healthcare regulatory requirements, and the ability to effectively communicate audit findings to providers, operational leaders, attorneys, and executive stakeholders. /ppThe Ophthalmic Compliance Auditor will serve as a trusted resource to clients and internal team members, providing subject matter expertise in coding and documentation. Responsibilities include conducting documentation audits, delivering provider education, supporting due diligence and compliance engagements. /ph3Key Tasks Responsibilities /h3ulliWork as part of an audit team to professionally and successfully complete client projects, meeting productivity and quality standards within established deadlines. /liliAccess necessary medical record documentation from client EMR/PM systems. /liliComplete detailed analysis of medical records for chart content and documentation requirements. /liliUtilize audit reporting tools to document audit results and prepare reports for quality assurance review and client delivery. /liliInterpret and apply CMS, AMA, OIG, NCCI, and other payer guidance to audit findings and compliance recommendations. /liliIdentify documentation, coding, billing, and risk trends and communicate findings to clients and internal leadership. /liliPrepare and present audit results, executive summaries, and compliance recommendations to providers, administrators, and senior leadership. /liliDevelop reports of audit findings and corrective action plans based on identified issues. /liliConduct education and training sessions for internal team members and clients as directed. /liliEducate and serve as a resource for providers regarding documentation and compliance matters. /liliParticipate in quality assurance reviews and peer review activities to ensure consistency and accuracy of audit outcomes. /liliAssist with the development and maintenance of audit tools, educational materials, methodologies, and compliance resources. /liliCoordinate, research, and access resources necessary for the execution of key client projects. /liliAssist leadership in ensuring client projects are delivered on time, within scope, and within budget. /liliSupport the development and clarification of project scope and objectives while engaging relevant stakeholders and confirming project feasibility. /liliDevelop and maintain relationships with clients and key stakeholders. /liliReview quality assurance audit reports and implement necessary corrections and adjustments. /liliMaintain current knowledge of government regulatory compliance guidance and third-party payer requirements as needed. /liliMaintain awareness of healthcare auditing principles, practices, and related compliance topics to ensure professional competence. /liliTech and internet savvv; experience with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) to complete assigned tasks. /li /ulh3Experience /h3pA minimum of 5 - 10 years of hands-on experience in a practice setting, having served as a skilled technician, scribe, or clinic manager, demonstrating a strong understanding of clinical /ppoperations and diseases common in ophthalmology and/or optometry or a minimum of 3 years of healthcare auditing, documentation review, compliance, or regulatory experience or a /pulliExperience auditing professional coding within Ophthalmology and/or across multiple specialties and service settings a plus. /liliExperience analyzing payer policies, regulatory guidance, and reimbursement requirements and translating findings into actionable recommendations. /liliExperience presenting written reports to providers, executives, and/or compliance leadership. /liliExperience working independently in a consulting or client-service environment preferred. /li /ulh3Knowledge Skills Section /h3ulliStrong knowledge of CPT, HCPCS, ICD-10 and Ophthalmology / Optometry-related codes and related CMS guidelines. /liliA thorough understanding and adherence to HIPAA regulations. /liliFamiliarity with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing procedures. Specific expertise in ophthalmology highly desirable. /liliCommitment to remaining current and informed on developing issues and trends in medical coding procedures requirements. /liliAdvanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, and healthcare reimbursement principles. /liliAbility to evaluate complex documentation scenarios and apply nuanced regulatory guidance to support defensible audit conclusions. /liliStrong written communication skills, including audit report writing, corrective action development, and executive-level communications. /liliStrong organization, communication, analytical, problem-solving, and time management skills necessary to be able to keep pace with fast-moving client projects. /liliAbility to effectively facilitate provider education. /liliAbility to identify trends, interpret data, and develop practical, risk-based recommendations. /liliDemonstrated professionalism and executive presence when interacting with clients and stakeholders. /liliWillingness to work with established team members to achieve consensus on key billing and coding issues. /liliA flexible, collaborative approach to managing variable daily tasks and customer types, both internal and external. /liliA dedication to high-quality, detail-oriented work. /liliSelf-directed and motivated, with the ability to work independently, prioritize responsibilities, and maintain productivity in a remote work environment /li /ulh3Certifications /h3h3Required /h3ulliJCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired. /liliMust be willing to achieve coding certification/s. COE is highly beneficial. /liliSome travel required /li /ulh3Preferred /h3ulliCPMA /liliCHC /liliCPCO /liliCRC /liliRHIA /liliRHIT /liliCOC /li /ul