Auditor, Clinical Services

Select Medical • Addison, TX

20h

About The Position

Concentra is recognized as the nation’s leading occupational health care company. With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America’s workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees. The Clinical Services Auditor is responsible for conducting comprehensive audits of occupational health and therapy billing services to ensure adherence to federal, state, and organizational compliance standards. Operating under the direction of the Compliance & Coding Audit Manager, the role supports Concentra’s compliance framework by identifying risk, promoting billing integrity, and ensuring accurate and compliant documentation and billing practices.

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
• 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
• Ability to work independently and collaboratively across different departments
• Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access and similar databases
• Working knowledge of routine and non-routine concepts, practices and procedures within billing and coding
• Excellent process and time management skills
• High degree of accuracy and attention to detail
• Organized and ability to analyze multiple sources of data
• Proficient written, oral communication
• Work independently and as part of a team
• Able to multi-task
• Ability to meet multiple deadlines
• Familiarity with state specific workers' compensation regulations
• Coding analytics experience

Nice To Haves

• Prior experience with therapy services and occupational health services preferred but not required
• Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
• Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
• The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
• Expertise in scheduling and facilitating
• Training and presentation skills (in person and virtual)

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED