Compliance Auditor
Hybrid · Chesapeake, Virginia, United States
Job Summary
Compliance Auditor responsible for planning, scheduling, and performing comprehensive internal professional and hospital fee audits (routine, focused, for cause, and not-for-cause) for CRH and affiliates; detecting documentation, coding, and billing errors; communicating audit results to providers, coders, management, and staff; developing and delivering provider/coder education; evaluating internal controls to ensure regulatory compliance with CMS, OIG, and related standards; staying current on regulations; serving as SME on documentation and coding rules; developing audit plans based on government studies; compiling and presenting audit reports to senior leadership and committees; conducting external audits and participating in voluntary disclosures; preparing CAPs and following up on corrective actions; coordinating with Corporate Compliance and HIM/Revenue Cycle teams; delivering curriculum to physicians and coding staff; and performing ongoing assurance activities across multiple departments.
Required Qualifications
- Experience as a coder in a hospital and/or healthcare environment
- Extensive knowledge of evaluation and management coding, modifiers, provider-based billing, and auditing principles
- American Academy of Professional Coders (AAPC) coding certification (such as CPC or CPB) or to obtain within one year of hire
- Understanding of industry rules, guidelines, and regulations
- Strong attention to detail, analytical and statistical skills
- Strong communication and multitasking skills
- Dedication to objectivity
- Experience in healthcare revenue cycle, auditing, clinical operations and/or compliance preferred
- Knowledge of DRG, CPT, CDM and billing operations
- Knowledge of hospital department operations
- Knowledge of EPIC and Athena EMR
- Strong skills with Microsoft Excel, Word, PowerPoint
- Strong verbal and written communication skills
- Preferred: CPMA or other auditing certification
- Bachelor’s degree in Nursing, Healthcare Administration, Business, and/or Accounting
- Health Care Compliance Association (HCCA) membership and certification
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