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Coding & Compliance Auditor
VMG Health. Provide auditing, compliance, education, and consulting services to healthcare clients .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in healthcare auditing, compliance, and documentation review, with a strong focus on ophthalmology-related coding and regulatory guidance. Capable of developing actionable recommendations and facilitating provider education while maintaining high standards of quality and productivity.
Highest-signal resume keywords
Ophthalmic Compliance AuditingCPT, HCPCS, ICD-10 CodingHealthcare Reimbursement PrinciplesAudit Report WritingJCAHPO Certification (COA, COT, COMT)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Healthcare AuditingDocumentation ReviewRegulatory ResearchCoding AnalysisQuality AssuranceData InterpretationCorrective Action DevelopmentProvider EducationCompliance RecommendationsProject Management
Soft Skills
Strong Written CommunicationAnalytical SkillsProblem-SolvingTime ManagementCollaboration
Tools & Technologies
EMR/PM SystemsAudit Reporting ToolsMicrosoft Office Suite
Certifications & Qualifications
JCAHPO Certification (COA, COT, COMT)CPCCPMAOCSCOPC
Industry Keywords
HIPAA RegulationsOphthalmologyCompliance Auditing MethodologiesPayer PoliciesRegulatory Guidance
About the role
Key responsibilities & impact- Provide auditing, compliance, education, and consulting services to healthcare clients
- Conduct documentation and coding reviews, regulatory research, and provider education
- Work as part of an audit team to complete client projects within productivity, quality, and deadline standards
- Access medical record documentation from client EMR/PM systems
- Analyze medical records for chart content and documentation requirements
- Use audit reporting tools to document results and prepare reports for quality assurance review and client delivery
- Interpret CMS, AMA, OIG, NCCI, and payer guidance for audit findings and compliance recommendations
- Identify documentation, coding, billing, and risk trends and communicate findings
- Prepare and present audit results, executive summaries, and compliance recommendations
- Develop audit findings reports and corrective action plans
- Conduct education and training sessions for internal team members and clients
- Educate providers on documentation and compliance matters
- Participate in quality assurance and peer review activities
- Assist with audit tools, educational materials, methodologies, and compliance resources
- Coordinate and research resources for client projects
- Assist leadership with on-time, in-scope, and on-budget project delivery
- Support project scope and objective development and stakeholder engagement
- Develop and maintain client and stakeholder relationships
- Review quality assurance reports and implement corrections
- Maintain current knowledge of government regulatory guidance and payer requirements
- Maintain awareness of healthcare auditing principles and compliance topics
Requirements
What you’ll need- Experienced Ophthalmic Compliance Auditor
- Minimum of 5–10 years of hands-on experience in a practice setting as a skilled technician, scribe, or clinic manager, or minimum of 3 years of healthcare auditing, documentation review, compliance, or regulatory experience
- Experience analyzing payer policies, regulatory guidance, and reimbursement requirements and translating findings into actionable recommendations
- Experience presenting written reports to providers, executives, and/or compliance leadership
- Experience working independently in a consulting or client-service environment preferred
- Strong knowledge of CPT, HCPCS, ICD-10, and Ophthalmology/Optometry-related codes and CMS guidelines
- Thorough understanding of and adherence to HIPAA regulations
- Familiarity with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing procedures
- Specific expertise in ophthalmology highly desirable
- Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, and healthcare reimbursement principles
- Ability to evaluate complex documentation scenarios and apply nuanced regulatory guidance
- Strong written communication skills, including audit report writing, corrective action development, and executive-level communications
- Strong organization, communication, analytical, problem-solving, and time management skills
- Ability to facilitate provider education
- Ability to identify trends, interpret data, and develop practical, risk-based recommendations
- Demonstrated professionalism and executive presence with clients and stakeholders
- Willingness to work with team members to achieve consensus on billing and coding issues
- Flexible, collaborative approach to variable tasks and customer types
- High-quality, detail-oriented work
- Self-directed and motivated; able to work independently, prioritize responsibilities, and maintain productivity remotely
- Tech and internet savvy; experience with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)
- JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired
- Must be willing to achieve coding certification(s)
- COE highly beneficial
- Preferred certifications: CPMA, CHC, CPCO, CRC, RHIA, RHIT, COC
Benefits
Comp & perks- Fully remote work arrangement
- Some travel required