Internal Auditor, Corporate Compliance Billing & Coding (Hybrid)

Purpose of Position

The Coding and Billing Compliance Auditor plays a critical role in ensuring the accuracy, integrity, and regulatory compliance of clinical documentation, coding, and billing practices across the health system. This position is responsible for conducting audits, identifying discrepancies, and providing education to staff to reduce risk, prevent fraud, and optimize reimbursement. By maintaining adherence to federal and state regulations, payer guidelines, and internal policies, the auditor helps safeguard the organization’s financial health and promotes ethical, transparent operations across all departments.

Qualifications

• Bachelor’s degree (or higher) preferably in Law, Healthcare, Compliance, Finance, Business, or Accounting
• Minimum of five years’ experience in physician coding, including auditing experience
• Current certification: CPC (Certified Professional Coder) through AAPC or CCS-P (Certified Coding Specialist – Physician-based) through AHIMA (Preferred) – Specialty in E&M CEMC (Certified Evaluation and Management Coder) through AAPC, or CPMA (Certified Professional Medical Auditor) through AAPC
• Comprehensive knowledge of coding standards including ICD-9 and ICD-10, CPT, and physician billing requirements, as well as physician reimbursement methodologies
• Strong verbal and written communication skills, with the ability to effectively interact with a wide range of individuals across clinical and administrative settings
• Proficiency with software applications related to electronic health records (EHR) and billing systems to ensure accurate documentation and reporting
• Proven ability to develop and deliver training materials that enhance understanding and compliance in coding, billing, and documentation practices
• Skilled in building and maintaining positive working relationships with physicians and interdisciplinary teams to promote collaboration and adherence to compliance standards