Clinical Operations Auditor

Cleveland Clinic•Independence, MO

5d•Hybrid

About The Position

The Clinical Operations Auditor conducts clinical operations audits, including quality medical chart reviews, under the supervision of the department Manager or Director. The role plans and performs audit tests and procedures to evaluate internal controls and compliance with organizational policies, Medicare regulations, The Joint Commission standards, and other applicable requirements. It also supports auditing and monitoring of medical necessity and regulatory compliance, and reviews clinical documentation and revenue cycle processes to identify workflow improvements, strengthen compliance, and support patient safety and quality. The position combines clinical knowledge with analytical and investigative work, including reviewing clinical information, analyzing data in Excel, and documenting audit findings. The team uses technologies including AI and Copilot tools to support audit activities and report writing. The role requires onsite auditing at Cleveland Clinic locations and collaboration with clinical teams and other stakeholders. The schedule is hybrid, 8:00 a.m. to 5:00 p.m., with two days per week onsite at the West Creek location in Independence. Travel to Cleveland Clinic locations is required and may include Main Campus, Fairview, Mentor, Hillcrest, or other locations as needed. Occasional flexibility outside standard onsite days may be required.

Requirements

Associate degree in a related field, a Nursing degree, or Nursing School graduate, plus four years of functionally relevant work in a hospital setting; OR high school diploma/GED, four years of functionally relevant hospital work, and an additional two years of relevant experience.
Must hold one of the following: Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Professional Coder (CPC), Certified Medical Audit Specialist (CMAS), Certified Professional Coder Hospital (CPCH), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
Comprehensive knowledge of accounting, clinical operations, and information technology principles and practices, auditing standards, analytical techniques, and internal controls.
Ability to travel to various Cleveland Clinic locations to conduct audits.

Nice To Haves

Bachelor’s degree.
Registered Nurse (RN) or LPN with clinical experience.
Nurse with coding experience.
Healthcare auditing experience.
Experience in clinical operations, revenue cycle, or compliance auditing.
Flexibility with work location and onsite auditing.
Excel/Microsoft experience.

Responsibilities

Conduct clinical operations audit assignments, including quality medical chart reviews, under the supervision of the department Manager or Director.
Plan and perform audit tests and procedures to evaluate internal controls related to compliance, organizational objectives, operational reporting, efficient resource use, and fraud deterrence and detection.
Collect and analyze data from diverse sources using appropriate computer-assisted auditing techniques.
Perform gap analyses of revenue cycle processes and recommend improvements.
Assist with auditing and monitoring compliance with medical necessity and regulatory requirements.
Conduct audits of clinical documentation and billing processes to evaluate accuracy and compliance.
Collaborate with clinical teams to identify and mitigate clinical issues.
Work with revenue cycle teams on billing and documentation audits.
Support internal controls that promote patient safety and quality.
Perform onsite visits to regional hospitals and Main Campus, with travel and occasional flexibility outside standard onsite days.
Develop and document audit findings, including recommendations to improve controls and reduce or recover costs.
Document audit findings using established protocols; training will be provided.
Participate in audit conferences and prepare written reports communicating audit findings and recommendations.
Perform special projects and assignments as requested by departmental management.
Comply with the Institute of Internal Auditors (IIA) Standards for the Professional Practice of Internal Auditing and Code of Ethics.
Perform other duties as assigned.