Sr Compliance Auditor

US Anesthesia Partners, Inc. • Remote,

8d

About The Position

The Sr Compliance Auditor audits assigned diagnostic and procedure codes against patient records to ensure compliance with federal, state, and regulatory requirements, payer requirements, and USAP policies and procedures. The role provides accurate, meaningful, and timely audit reports and findings to management and communicates audit results, documentation guidelines, and other compliance information to management and providers.

The position leads scheduled and requested audits focused on anesthesia documentation, billing, and coding; evaluates clinical documentation; identifies risks and variances; and prepares, analyzes, and presents audit reports. It also supports corrective action plans and remediation, trains and mentors auditors and healthcare providers, coordinates external audits, and serves as a resource on documentation, coding, claim review, and billing. The Sr Compliance Auditor maintains current knowledge of applicable laws and guidance, protects confidential information, and may perform other duties as assigned.

Requirements

• High school diploma or equivalent required.
• At least 7 years of anesthesia coding experience, or an equivalent combination of education and coding experience.
• Previous auditing experience required.
• Medical coding certification required: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Expert knowledge of CPT, ASA, and ICD-10 coding, and of managed care, Medicare, Medicaid, and workers’ compensation billing and coding rules, regulations, and guidance applicable to anesthesia.
• Expert understanding of auditing methodologies and compliance frameworks.
• Strong written and verbal communication skills, including high-level report writing.
• Critical thinking, problem-solving, and data analysis skills to identify discrepancies and complex coding patterns.
• Advanced research skills for gathering, researching, and reporting information.
• Time management, prioritization, and organizational skills to manage multiple projects and meet deadlines.
• Ability to independently investigate, analyze, and resolve complex or non-routine issues.
• Ability to lead projects, mentor staff, collaborate with coding, clinical, and revenue cycle departments, and communicate effectively with staff, providers, leadership, and stakeholders.
• Working knowledge of computers and ability to use word-processing, spreadsheet, and database programs.
• High attention to detail and accuracy.
• Professional demeanor and ability to work effectively with diverse personalities and in cross-functional environments.
• Ability to meet the physical requirements of the role, with or without reasonable accommodation.

Nice To Haves

• Associate or bachelor’s degree in a related field.
• Experience leading or overseeing audit programs in whole or in part.
• Advanced certification as a Certified Anesthesia and Pain Management Coder (CANPC).
• Certified Professional Medical Auditor (CPMA) or Certified Healthcare Auditor (CHA) certification.

Responsibilities

• Lead and conduct continuous audits on a predetermined schedule and as needed or requested, focusing on anesthesia documentation, billing, and coding compliance.
• Evaluate clinical documentation for compliance with coding, documentation, and billing laws, regulations, and guidelines, helping safeguard against fraud, waste, and abuse.
• Contribute to audit planning, identify potential risk areas, and communicate results to compliance leadership.
• Prepare and review medical records to assess documentation, coding, and charge accuracy and identify variances.
• Analyze, prepare, and present audit reports.
• Develop and deliver targeted communications, training sessions, and educational programs for healthcare providers based on audit findings in billing, coding, and medical record documentation.
• Communicate documentation, coding, and charge errors and trends identified in audits to compliance leadership.
• Coordinate with compliance leadership on corrective action plan approval and liaise with operations to ensure findings are remediated, action plans are sustained, and emerging risks are identified.
• Onboard and train new compliance auditors; serve as a subject matter expert who provides guidance and reviews junior auditors’ work.
• Co-define and lead preparation for external audits, coordinate information requests, and track external auditor deliverables to support timely completion.
• Manage audit schedules, maintain accurate records of audit activities, and coordinate meetings and training sessions as needed.
• Provide guidance on documentation, coding, claim review, and billing questions; monitor payer bulletins, periodicals, and websites and stay current on applicable laws, regulations, and guidelines.
• Define audits, identify risks, develop action plans, document findings, draft reports, and communicate results to compliance leadership and/or the Compliance Committee.
• Participate in educational programs, training sessions, and meetings as requested or required.
• Co-define and execute special projects in collaboration with compliance leadership.
• Maintain strict confidentiality of sensitive information, including patient records and audit reports.
• Perform other duties as assigned or requested.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED