Auditor, Clinical Services
Concentra · Addison, TX · 3 wk ago
AccountingFull-time
Responsibilities
- Perform scheduled and ad hoc audits of occupational health and therapy billing, coding, and documentation, with emphasis on services billed to payors.
- Evaluate occupational health and therapy-related coding for accuracy, medical necessity, time-based coding compliance.
- Assess compliance with applicable federal and state regulations, payor-specific guidelines, and Concentra’s internal policies.
- Identify and document billing discrepancies, coding variances, and potential compliance risks, including over coding, under coding and insufficient documentation.
- Prepare detailed audit reports outlining findings and recommendations for leadership review.
- Provide structured feedback and education to therapy providers, physicians, and non-physician providers to enhance documentation quality and coding accuracy.
- Collaborate with the Compliance & Coding Audit Manager to support annual audit plans and compliance initiatives.
Qualifications
- Education Level: High School Diploma or GED
- Professional certification: Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) with the intention of becoming certified as CPMA within 1 year
- Has at least 2 years of experience in coding and compliance auditing
- Proficiency in CPT, ICD-10, HCPCS, and therapy specific time-based coding methodologies
- Demonstrated knowledge of payor regulations and requirements
- Experience with electronic health record (EHR) systems and billing platforms
- Exceptional analytical, organizational, technical, and communication skills
- The ability to work independently and collaboratively across different departments
- Prior experience with therapy services and occupational health services preferred but not required
Employee Benefits
- 401(k) Retirement Plan with Employer Match
- Medical, Vision, Prescription, Telehealth, & Dental Plans
- Life & Disability Insurance
- Paid Time Off
- Colleague Referral Bonus Program
- Tuition Reimbursement
- Dependent Care Spending Account
- Employee Discounts