Auditor, Clinical Services

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