Compliance Auditor
Core
Conduct coding, billing, and documentation audits for Medical Oncology, Radiation Oncology, and Urology services to ensure adherence to regulatory requirements and payer policies.
Role type
Senior IC compliance auditor (healthcare coding)
Builds
Audit reports and corrective action recommendations
Domain
Healthcare / Medical Coding & Compliance
Required skills
Healthcare coding (CPT, HCPCS, ICD-10-CM), regulatory compliance analysis, claim review, trend analysis, audit reporting, payer policy interpretation
Preferred skills
Coding certification (AAPC, AHIMA), mentorship, policy development
Technologies
CPT, HCPCS, ICD-10-CM
Responsibilities
Conduct coding, billing, and documentation audits to identify compliance, coding, and reimbursement risks; Review medical records and claims to ensure compliance with regulatory, payer, and organizational requirements; Analyze audit findings, identify trends and opportunities for improvement, and recommend corrective actions; Prepare audit reports and communicate findings to leadership, providers, coders, and operational stakeholders; Provide education and guidance to physicians, coders, and staff on coding, documentation, compliance requirements, and industry best practices; Research coding and documentation questions to support accurate code assignment and reimbursement; Assign and validate ICD-10-CM, CPT, HCPCS, and modifier usage for professional and facility services as applicable; Coordinate responses to external audit and medical record requests and ensure timely submission of required documentation; Maintain current knowledge of coding guidelines, payer policies, and healthcare regulations impacting Medical Oncology, Radiation Oncology, and Urology services.
Seniority
Senior, hands-on IC
