Senior Compliance Coding Auditor

Wellpath•Franklin, TN

12h

About The Position

The Sr Compliance Coding Auditor performs complex coding audits across a range of services, including those delivered in correctional settings and through third-party billing vendors. This role serves as a subject matter expert on coding and documentation guidelines, identifying risks and preparing detailed audit findings. The position works closely with leadership to develop corrective actions and deliver education to providers and coders. This role also supports regulatory audits and provides guidance and mentorship to compliance staff.

Requirements

Bachelor's degree in Health Information Management, Healthcare Administration, or a related field preferred
Associate's degree with substantial equivalent professional coding and auditing credentials and experience may be considered
Completion of formal coding and/or auditing training program (AAPC, AHIMA, or equivalent) required
Minimum five (5) years of progressively responsible experience in professional coding and coding audit
Demonstrated experience performing complex E/M, primary care, chronic disease management, behavioral health, and/or medication-assisted treatment (MAT) audits using AMA CPT, ICD-10-CM, HCPCS, and CMS guidance
Experience preparing detailed audit findings reports and presenting results to providers, coders, and operational leadership
Working knowledge of OIG, CMS, AMA, and payer-specific compliance and documentation requirements
Certified Professional Medical Auditor (CPMA) through AAPC — required, and/or
Certified Professional Coder (CPC) — required

Nice To Haves

Experience auditing or overseeing third-party billing vendors strongly preferred
Familiarity with state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows strongly preferred
Previous correctional/detention facility coding or auditing experience preferred
Certified E/M Coder (CEMC) or Certified Professional Compliance Officer (CPCO) credential strongly preferred
Certified Professional Biller (CPB) through AAPC — preferred, given the role's emphasis on third-party billing vendor oversight and government-program payer requirements
Certified Coding Specialist (CCS) through AHIMA may be substituted for an AAPC equivalent

Responsibilities

Plan and conduct complex coding audits using risk-based sampling and established methodologies.
Review provider documentation, coding, and modifier usage to ensure compliance with coding standards and payer rules.
Analyze findings, prepare detailed audit reports, and present results to providers, coders, and leadership.
Support corrective action planning, education efforts, and monitoring of compliance trends and regulatory updates.
Provide guidance to compliance staff and support external audits, vendor oversight, and regulatory inquiries.