Compliance Auditor

Compliance Auditor

Nextcare, Inc. | Tempe, AZ, 85280, US

Posted 4 days ago

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NextCare Introduction

NextCare strives to be the leader in high access healthcare, offering urgent care, occupational health, virtual health and primary care services to our patients. With offering services in twelve states (Arizona, Colorado, Kansas, Michigan, Missouri, New Mexico, Nebraska, North Carolina, Oklahoma, Texas, Virginia and Wyoming) and over 170 urgent care clinic locations, we offer exceptional, affordable care to patients across the country.

At NextCare, we constantly strive to provide you with the highest degree of caring, growth, integrity, results and teamwork. These essential core values form the foundation of our relationships with patients, customers, investors, partners and one another. Extraordinarily high-performance standards serve as critical guides for making important clinical and business decisions. The expression of these standards is evident in our behavior, our attitude, and our approach to our daily work. The product of our strict adherence to core values is the ability to harness tremendous organizational energy to achieve our goal of upholding the highest standard for quality and service within the high access healthcare. This unique combination of values, performance standards and commitment serves as the key to our success.

What we are looking for

NextCare is looking for a Compliance Auditor.


To join their team in Tempe, AZ or work remotely from one of the 12 states which NextCare currently operates.


The Compliance Auditor is responsible for

* Following established protocols, selects and reviews a percentage of records to assess coding documentation, billing and/or reimbursement practices for professional billing documentation compliance with all regulations of federal and state agencies and third party payors and company policy.
* Maintain and review data and provide feedback to providers on audit scores. Assign performance scores and risk rating based on audit results.
* In conjunction with appropriate personnel, investigate, evaluate, and identify opportunities for improvement and recognize their relative significance in the overall system and provide guidance to departments regarding internal controls.
* Assist Chief Compliance Officer to identify risk areas and develop audit plan to address.
* Develop and maintain professional skills and knowledge through educational programs, participation in professional organizations, and review of current regulations and literature.
* Contribute to the teamwork within and between departments and organizations that support clinic operations.
* Provide positive and effective customer service that supports departmental and hospital operations.
* Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
* Performs other related duties as assigned or described in Company policy.

How you will make an impact

The Compliance Auditor serves to educate, encourage, and assist those across the NextCare system to always do the right thing. The Compliance Auditor does this by: (1) auditing claims prepared by individual providers in accordance with compliance policies and reporting audit findings to the General Counsel & Chief Compliance Officer; (2) reporting on audit findings to providers and providing training and education on audit findings to ensure that the services we bill to Federal and State programs comply with defined requirements for billing; (3) identifying billing related risk areas and devising and conducting audits of such risk areas; (4) serving as a resource for and authority on issues related to the documentation, coding, and billing of professional services; (5) keeping current on all applicable legal and regulatory requirements and ensuring that guidance and audit standards conform to such requirements; (6) reviewing and developing department and organization policies that promote compliance with all applicable legal and regulatory requirements; (7) engaging in special investigations when requested by the General Counsel & Chief Compliance Officer; and (8) modeling the NextCare values.

Essential Education, Experience and Skills:


* Minimum of High School Diploma or equivalent


* Professional Billing Coding Certification (CPC, CCS-P, CEMC, CFPC) required


* Minimum of one year experience reviewing physician documentation and assisting physicians to meet government and other third party payor and CPT/ICD10 coding requirements through individual and group training sessions OR at least 3 years coding experience directly applying codes.
* Knowledge of healthcare compliance regulations


* The analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize the information and data in order to solve problems.
* Excellent communication skills in order to effectively deal with conflicting views or issues and mediate fair solutions
* Well-developed writing skills
* Ability to work independently on assigned tasks as well as to accept direction on given assignments.

Valued But Not Required Education, Experience and Skills:

Education: Minimum of Associate Degree or Bachelors Degree


* Billing and coding experience in an urgent care or primary care setting
* Familiarity with NextGen EMR


NextCare offers full time employees medical, health savings account, NextCare employee visit program, dental, vision, basic life, voluntary employee/spouse/child life, long term disability, short term disability, employee assistance program, critical illness, accident, legal, identity theft and paid time off benefits. Employees of all statuses are offered 401(k) Plan benefits. Employees in select positions are offered shift differential benefits. Benefits are offered per policy and plan rules.

Equal Opportunity Statement

NextCare Urgent Care is an Equal Opportunity Employer.