Compliance Billing & Coding Auditor

UMC Health System•Richmond, KY

About The Position

The Healthcare Compliance Billing & Coding Auditor is responsible for performing independent audits of billing and coding practices across hospital departments and clinic providers to ensure compliance with organizational policies, federal and state regulations, and payer requirements.

Requirements

+3 years of experience in hospital and clinic compliance, billing, and coding audits
Strong knowledge of CMS regulations, HIPAA, and payer guidelines.
CPC, CCS, or equivalent coding certification required.
Must obtain Certified Professional Medical Auditor (CPMA) from AAPC, which demonstrates expertise in auditing, compliance, and risk-based methodologies, within 12 months of hire date.
Experience with electronic health records (EHR) and audit software (i.e. Cerner, EPIC, Healthicity, Nektar).
Able to work independently and manage multiple audits simultaneously.
Excellent communication and reporting skills.
Ability to work autonomously while collaborating with compliance and revenue cycle teams.
Visual and auditory acuity are required continuously.
Ability to speak is required frequently.
Sitting, walking, and standing for extended periods of time may be required.

Nice To Haves

Bachelor’s degree.

Responsibilities

Conduct comprehensive audits of billing and coding documentation for accuracy and compliance in both hospital and clinic settings.
Identify discrepancies, potential compliance risks, and recommend corrective actions.
Develop audit reports and present findings to leadership.
Stay current with regulatory changes, coding guidelines (ICD-10, CPT, HCPCS), and compliance standards.
Collaborate with clinical and administrative teams to implement best practices.
Assist in compliance training related to billing and coding.
Perform additional compliance and research-related responsibilities as needed to support organizational objectives.