Compliance Auditor

Cardinal Health; Oregon; Ibrido; USD 80.000 - 105.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental and vision coverage

Paid time off plan

Health savings account

Descrizione del lavoro

Cardinal Health is seeking a Compliance Auditor to perform coding, documentation audits and education across Medical Oncology, Radiation Oncology and Urology services. The role emphasizes expertise in CPT, HCPCS, ICD-10-CM, reimbursement methodologies and healthcare regulations.

The ideal candidate will analyze complex claims, identify risks, and deliver actionable recommendations, fostering collaboration with physicians, coders and operational teams to improve compliance and billing accuracy.

Competenze

• Coding certification from an accredited source (AAPC, AHIMA, etc.)
• 4-8 years of experience, preferred
• Undergraduate degree, preferred

Mansioni

• 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.

Conoscenze

Experience (4-8 yrs)

Formazione

Undergraduate degree, preferred

Descrizione del lavoro

What Ethics & Compliance contributes to Cardinal HealthEthics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.

Job SummaryThe Compliance Auditor is responsible for conducting coding, documentation audits to ensure adherence to regulatory requirements, payer policies, and organizational standards. This position 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 Compliance Auditor performs detailed claim reviews, identifies coding and documentation risks, analyzes trends, develops recommendations for improvement, and delivers education to providers, coders, and operational teams. The ideal candidate enjoys analyzing complex claims and medical records, possesses exceptional attention to detail, can identify broader compliance and operational implications, and demonstrates a strong commitment to collaboration, education, and continuous improvement.

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.

Qualifications

• Coding certification from an accredited source (AAPC, AHIMA, etc.)
• 4-8 years of experience, preferred
• Undergraduate degree, preferred

What is expected of you and others at this level

• Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects
• May contribute to the development of policies and procedures
• Works on complex projects of large scope
• Develops technical solutions to a wide range of difficult problems
• Solutions are innovative and consistent with organization objectives
• Completes work; independently receives general guidance on new projects
• Work reviewed for purpose of meeting objectives
• May act as a mentor to less experienced colleagues

Anticipated salary range: $79,700 - $105,480

Bonus eligible: No

Benefits

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day.

Cardinal Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.