Compliance and Audit Specialist
The Compliance and Audit Specialist is responsible for supporting the organization’s compliance efforts through effective documentation oversight and audit preparation. This role ensures documentation is current, organized, and aligned with regulatory and billing standards, while also driving improvements in audit processes and maintaining audit readiness. The Specialist works closely with the Director of Compliance to ensure consistent, audit-ready documentation practices across the organization.
ESSENTIAL DUTIES AND RESPONSIBILITIES
• Conduct audits and assessments to evaluate the quality of emergency medical services, with day-to-day tasks including reviewing documentation to ensure compliance and accuracy.
• Ensure that documentation supports compliant claim submission by verifying medical necessity, service accuracy, and alignment with payer and regulatory requirements.
• Verify that EMS documentation and credentialing practices meet all applicable federal, state, and local regulations, including CMS, HIPAA, and commercial payers.
• Collaborate with billing and coding teams to ensure complete, accurate, and billable documentation that reduces denials and minimizes audit risk.
• Detect patterns of non-compliance or documentation deficiencies that may affect billing, thoroughly documenting findings and recommending corrective actions.
• Assist with investigations into potential billing or documentation concerns, providing findings to the Compliance team and leadership for further action.
• Lead efforts to identify and implement process improvements that enhance the effectiveness and efficiency of audit readiness and documentation practices.
• Ensure all documentation processes are aligned with the company's audit requirements and regulatory standards.
• Collaborate with the Director of Compliance to ensure continuous audit readiness, including preparing for upcoming audits and proactively addressing potential audit gaps.
• Support the innovation of audit workflows by researching and implementing industry best practices and technological solutions to streamline audit-related tasks.
• Assist in the development and refinement of audit preparation protocols and documentation processes based on internal audits and external findings.
• Perform additional Quality Assurance (QA) and audit-related tasks as necessary, supporting continuous improvement in audit processes and documentation quality.
• Conduct 90-day documentation reviews to ensure all records are current, accurate, and compliant with internal standards and regulatory requirements.
• Participate in employee training and education related to documentation standards, compliance protocols, and audit procedures.
• Other job-related duties as assigned.
EDUCATION AND EXPERIENCE
• Minimum of an associate’s degree in healthcare administration, business administration, or a related field required.
• CACO and/or CADS certifications preferred, or the ability to earn them within one year of hire.
• Minimum of 2 years of experience in healthcare administration, compliance, billing, or a related field, with a preference for experience in ambulance billing and compliance.
• At least 2 years of experience in audit preparation and documentation management, with a focus on maintaining audit readiness and identifying process improvements.
• Additional certification in medical coding (e.g., CPC, CAC) is strongly preferred.
• Experience with EPCR systems (e.g., ESO, ImageTrend) and familiarity with EMS documentation workflows is a plus.
KNOWLEDGE, SKILLS, AND ABILITIES
• Experience in leading or coordinating audits, with a deep understanding of audit procedures and regulatory requirements.
• Knowledge of ambulance billing and compliance standards, including CMS, HIPAA, and commercial payers.
• Strong organizational skills with keen attention to detail.
• Proficiency in relevant software tools, such as billing systems and credentialing platforms.
• Strong problem-solving skills with the ability to proactively identify audit gaps and implement effective solutions.
• Ability to work in a fast-paced environment with frequent deadlines and shifting priorities.
• Excellent verbal and written communication skills, with the ability to maintain professionalism in all interactions.
WORKING CONDITIONS
Work is primarily performed on a computer, requiring long periods of sitting or standing at a workstation.
WORK LOCATION AND SCHEDULE
This is a hybrid position, requiring three days on-site in Terrell, TX and two days remote each week.
Emergicon requires satisfactory pre-employment background check and drug screenings.
EMERGICON LLC is an EEO employer - M/F/Vets/Disabled