Compliance Auditor

Role Overview

• Conduct detailed audits of compliance concerns including medical records to ensure accuracy in coding and billing practices.
• Review documentation to identify and correct coding and billing errors, ensuring compliance with medical necessity and regulatory guidelines.
• Log and track audit results and documentation workflows.
• Analyze trends and discrepancies in coding and billing practices, providing actionable insights and recommendations for improvement.
• Collaborate with internal teams to improve documentation standards and ensure compliance with relevant regulations.
• Independently organize and prioritize audit tasks to meet deadlines, adjusting priorities as necessary.
• Participate in process improvement initiatives, team meetings, and department projects to enhance audit workflows and overall efficiency.
• Maintain up-to-date knowledge of medical coding standards, HIPAA regulations, and compliance requirements.
• Provide recommendations to management on improving coding accuracy, documentation standards, and operational processes.
• Deliver adequate and timely reporting on the internal control framework and control deficiencies to ensure appropriate communication, documentation, escalation to the compliance officer.
• Cross functionally collaborate with department heads and build strong communication lines to maintain engagement with process implementation.
• Partner closely with Health Information Management and Quality Management teams to aid in audit efficiency and effectiveness, including the collection and delivery of information.
• Assist the Chief Compliance Officer, Risk with the development of the annual audit program.

Requirements

• 2+ years of relevant compliance auditing experience,
• Bachelor’s degree in Health Information Management or related field
• Professional Designation: CHC or willingness to obtain certification
• Experience in evaluating compliance with laws and regulations
• Proficiency in medical coding, billing practices and CMS requirements.
• Strong analytical skills for identifying trends, addressing discrepancies, and proposing solutions.
• Excellent organizational abilities to manage multiple audit tasks and meet deadlines.
• Deep understanding of HIPAA regulations, confidentiality, and compliance requirements.
• Ability to work both independently and collaboratively with cross-functional teams.
• Strong process analysis, risk and control identification, negotiation and problem solving skills
• Ability to build and maintain solid relationships across multiple levels of management including communicate with external auditors/consultants
• Strong project management skills
• Adaptive communication and change management skills
• Experience in organizations that use cloud-based/SaaS business systems, build SaaS products, and use agile software development methodology
• Ability and willingness to be hands-on and dive into details of processes and operations

Tech Stack

• Cloud

Benefits

• Comprehensive Medical, Dental and Vision plans coverage
• Pre-tax benefits: HSA/ FSA
• 401k Retirement Savings Program with matching up to 4%
• Voluntary benefits including disability, basic life or pet insurance, etc.
• Monthly Wellness Stipend to promote mental and physical self-care
• Flexible PTO and Remote First Environment
• Regular team events, including Wellness Workshops and Team Building Events
• Free access to Talkspace products for you and one household member, as well as access to a friends and family discount!