Compliance Auditor

Cardinal Health

22h•$79,700 - $105,480

About The Position

The Compliance Auditor conducts coding, billing, and documentation audits to ensure adherence to regulatory requirements, payer policies, and organizational standards. The role focuses primarily on Medical Oncology, Radiation Oncology, and Urology services and requires advanced knowledge of CPT, HCPCS, ICD-10-CM, reimbursement methodologies, and healthcare compliance regulations. The position reviews complex claims and medical records, identifies coding and documentation risks, analyzes trends, recommends improvements, and prepares audit reports. It also provides education and guidance to physicians, coders, and operational teams; researches coding and documentation questions; and coordinates responses to external audit and medical record requests. The auditor collaborates with Compliance, Revenue Cycle, Coding, Clinical, and Operational teams on monitoring activities and compliance initiatives. At this level, the employee applies comprehensive knowledge to varied tasks and complex projects, may contribute to policy and procedure development, and develops technical solutions to difficult problems. Work is completed independently with general guidance on new projects and reviewed for meeting objectives. The employee may mentor less experienced colleagues.

Requirements

Coding certification from an accredited source, such as AAPC or AHIMA.
Advanced knowledge of healthcare coding, auditing, and compliance principles, with demonstrated expertise in Medical Oncology, Radiation Oncology, and Urology services.
Strong collaboration and communication skills.
Detail-oriented and analytical approach, commitment to accuracy and continuous learning, and ability to balance detailed audit review with broader compliance risk assessment.

Nice To Haves

4–8 years of experience.
Undergraduate degree.

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.
Collaborate with Compliance, Revenue Cycle, Coding, Clinical, and Operational teams on monitoring activities and compliance initiatives.
Perform other duties as assigned.