Auditor, Clinical Services

Concentra is recognized as the nation’s leading occupational health care company. With more than 40 years of experience, Concentra is dedicated to improving the health of America’s workforce, one patient at a time. The Clinical Services Auditor supports Concentra’s compliance framework by identifying risk, promoting billing integrity, and ensuring accurate and compliant documentation and billing practices.

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, and 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.

Requirements

• 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.
• 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.
• Ability to work independently and collaboratively across different departments.
• Prior experience with therapy services and occupational health services preferred but not required.
• Ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies.
• Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access, and similar databases.
• Excellent process and time management skills.
• High degree of accuracy and attention to detail.
• Organized and able to analyze multiple sources of data.
• Proficient written and oral communication.
• Ability to work independently and as part of a team.
• Able to multi-task and meet multiple deadlines.
• Expertise in scheduling and facilitating training and presentations (in person and virtual).
• Familiarity with state-specific workers' compensation regulations.
• Coding analytics experience.

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
• Commuter Benefits
• Dependent Care Spending Account
• Employee Discounts

*This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.*