Job Description

Position Summary: We're seeking a Revenue Cycle Compliance Auditor who will perform thorough reviews of clinical documentation and coding to ensure services are billed accurately in compliance with payer and regulatory requirements. We welcome detail-oriented applicants who will work in collaboration with our internal compliance team to reduce systemic billing risk across our organization.

This role is largely education driven with an aim to identify trends and communicate meaningful solutions to our providers, administrators, staff, and payer partners.

Essential Job Functions:

• Conducts pre-bill and post-bill compliance audits across specialties and payers.
• Reviews E/M leveling, procedure coding, modifiers, and medical necessity.
• Interprets medical records and applies coding guidelines consistently across all billing aspects.
• Performs HCC coding review to assist with Value Based Care initiatives.
• Researches current industry standards by way of federal guidelines, payer policies, and creditable coding sources.
• Documents findings in a clear and defensible manner.
• Identifies patterns of risk by provider, specialty, and service-line.
• Supports payer audits, refund requests, and internal investigations.
• Leads provider and staff education based on audit findings.

Qualifications

• 5 or more years of professional coding experience required--specialty medicine experience preferred
• CPC or CCS required--specialty certifications a plus; CPMA optional but encouraged
• Prior experience performing coding or compliance audits
• Advanced knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and payer policies

Hours: Hours: Monday - Friday 8am to 5pm; Hybrid Position