Internal Auditor III

Sutter Health•Sacramento, CA

5d•$93,954 - $176,155

About The Position

Leads inpatient coding, billing compliance, and revenue integrity audits to evaluate regulatory compliance, identify risks, and improve operational effectiveness. Provides subject matter expertise and guidance to coding, CDI, revenue cycle, and operational teams while managing audits from planning through reporting in alignment with Sutter Health values and professional auditing standards.

Requirements

Extensive knowledge of hospital rules, regulations, coding and billing compliance requirements, NCDs, LCDs, and reimbursement methodologies.
Advanced expertise in ICD-10-CM/PCS, CPT, and HCPCS coding systems.
Ability to interpret regulatory guidance and provide accurate recommendations to operational, clinical, and revenue cycle teams.
Certified Coding Specialist (CCS).
Firm understanding of audit theory and processes and of the professional practice standards of internal auditing as well as core control frameworks.
Advanced analytical and project management skills, including the ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.
Ability to work independently, as well as part of a multidisciplinary team, while demonstrating excellent organization skills.
Ability to manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities.
Ability to maintain audit/project schedules.
Ability to meet tight and often conflicting deadlines.
Ability to analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems.
Ability to maintain strict confidentiality and ensure the privacy of each patient’s protected health information (PHI).
Ability to build collaborative relationships with peers, other departments, stakeholders, and external agencies.
Able to display a high degree of professionalism and leadership.
Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex technical or sensitive information related to audit activities clearly and professionally to diverse audiences.

Nice To Haves

RHIA, RHIT, CDIP, and/or CCDS credential.

Responsibilities

Lead inpatient coding, billing compliance, and revenue integrity audits.
Participate in annual risk assessments and audit plan development.
Manage audit engagements, including scope, timelines, budgets, and reporting.
Supervise and develop audit staff.
Provide guidance to coding, CDI, compliance, and revenue cycle teams.
Evaluate coding with regulatory, payer, and organizational requirements.
Identify coding, documentation, and reimbursement risks and recommend improvements.
Prepare audit reports and communicate results to leadership and stakeholders.
Support continuous improvement of audit methodologies, workflows, and tools.