Coding & Compliance Eye Auditor

Description

At 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.?

Position Summary

VMG 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.

The 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.

Key Tasks & Responsibilities

• Work as part of an audit team to professionally and successfully complete client projects, meeting productivity and quality standards within established deadlines.
• Access necessary medical record documentation from client EMR/PM systems.
• Complete detailed analysis of medical records for chart content and documentation requirements.
• Utilize audit reporting tools to document audit results and prepare reports for quality assurance review and client delivery.
• Interpret and apply CMS, AMA, OIG, NCCI, and other payer guidance to audit findings and compliance recommendations.
• Identify documentation, coding, billing, and risk trends and communicate findings to clients and internal leadership.
• Prepare and present audit results, executive summaries, and compliance recommendations to providers, administrators, and senior leadership.
• Develop reports of audit findings and corrective action plans based on identified issues.
• Conduct education and training sessions for internal team members and clients as directed.
• Educate and serve as a resource for providers regarding documentation and compliance matters.
• Participate in quality assurance reviews and peer review activities to ensure consistency and accuracy of audit outcomes.
• Assist with the development and maintenance of audit tools, educational materials, methodologies, and compliance resources.
• Coordinate, research, and access resources necessary for the execution of key client projects.
• Assist leadership in ensuring client projects are delivered on time, within scope, and within budget.
• Support the development and clarification of project scope and objectives while engaging relevant stakeholders and confirming project feasibility.
• Develop and maintain relationships with clients and key stakeholders.
• Review quality assurance audit reports and implement necessary corrections and adjustments.
• Maintain current knowledge of government regulatory compliance guidance and third-party payer requirements as needed.
• Maintain awareness of healthcare auditing principles, practices, and related compliance topics to ensure professional competence.
• Tech and internet savvv; experience with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) to complete assigned tasks.

Experience

A 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

operations 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

• Experience auditing professional coding within Ophthalmology and/or across multiple specialties and service settings a plus.
• 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.

Knowledge & Skills Section

• Strong knowledge of CPT, HCPCS, ICD-10 and Ophthalmology / Optometry-related codes and related CMS guidelines.
• A thorough understanding 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.
• Commitment to remaining current and informed on developing issues and trends in medical coding procedures requirements.
• 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 to support defensible audit conclusions.
• 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 necessary to be able to keep pace with fast-moving client projects.
• Ability to effectively facilitate provider education.
• Ability to identify trends, interpret data, and develop practical, risk-based recommendations.
• Demonstrated professionalism and executive presence when interacting with clients and stakeholders.
• Willingness to work with established team members to achieve consensus on key billing and coding issues.
• A flexible, collaborative approach to managing variable daily tasks and customer types, both internal and external.
• A dedication to high-quality, detail-oriented work.
• Self-directed and motivated, with the ability to work independently, prioritize responsibilities, and maintain productivity in a remote work environment

Certifications

Required

• JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS and/or COPC desired.
• Must be willing to achieve coding certification/s. COE is highly beneficial.
• Some travel required

Preferred

• CPMA
• CHC
• CPCO
• CRC
• RHIA
• RHIT
• COC