Overview

NVISION® Eye Centers is one of the largest ophthalmology providers in the U.S., with over eighty centers across six states including California, Nevada, Oregon, Arizona, Texas, and Utah. An innovative leader in ophthalmology, we are dedicated to providing the best patient experience through the use of the latest technology and treatment by the most talented and experienced surgeons in the industry. With more than 3,000 eye doctors referring their patients and trusting their own eyes to NVISION surgeons, NVISION Eye Centers is the Eye Doctors' #1 Choice®.

The Compliance Auditor position reports to the Chief Compliance Officer and is responsible for conducting claims reviews in accordance with NVISION’s internal audit and monitoring policy and providing claims review support for other internal and external claims review scenarios.

LOCATION:  Remote with travel as needed. Candidate must reside in one of the states NVISION operates in.

Responsibilities

PRIMARY RESPONSIBILITIES (Including but not limited to):  

Claims Review 

• Conducts both prospective and retrospective billing and coding claims review in accordance with the Company’s policy across the organization. 
• Responsible to review claims in accordance with Medicare and other federal payor documentation requirements. 
• Identify documentation anomalies and provide timely feedback to providers and administrative leaders. 
• Maintain claims review trending and data reports as needed. 
• Provide documentation training to providers and administrators as needed. 
• Provide support with external claims audits as needed.
• Maintain audit shell.
• Provide input to Chief Compliance Officer pertaining to policies and procedures. 
• Coach and provide feedback to site manager on regular cadence. 

Culture 

• Demonstrates a collaborative nature and creates a positive teamwork environment. 
• Works with business partners to identify opportunities for process and documentation improvement.
• Fosters a culture of teamwork between Compliance and the business units. 

Qualifications

KNOWLEDGE, SKILLS AND ABILITIES: 

• Five plus years of experience with billing and coding Medicare, Medicaid, and other federal payor claims. 
• Must have exceptional communication skills and be able to effectively communicate complex information with business partners.
• Expertise and experience in health care law and regulations is a plus. 
• An analytical mind and the ability to identify issues and provide solutions to address them. 
• Ability to develop trust and respect with both internal and external customers. 
• Polished communication and presentation skills both oral and written.

MINIMUM QUALIFICATIONS: 

• Certified medical coder with ophthalmology certification is required.
• In addition to an ophthalmology coding certified, a certified ophthalmology technician is preferred. 
• Bachelor’s degree in business or a related field or equivalent related work experience preferred.
• Preference will be given to candidates with experience in ophthalmology industry and/or Ambulatory Surgery Centers.
• Medium skill level with Excel 

PHYSICAL REQUIREMENTS:  

Requires sitting and working on computer/ looking at monitors the majority of the workday. Duties require sitting approximately 70%. Periodic travel and the ability to do so may be required 30-40% of the time as the business requires. 

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