Compliance Coding Auditor , ATM

Advanced Medical Management, Inc.; Long Beach (CA); On-site; USD 75,000 - 80,000; Full time

Benefits offered by this job

Full employer-paid HMO

Discounted vision and dental premiums

Flexible Spending Accounts (FSAs)

401(k) plan

Generous PTO and paid holidays

Tuition reimbursement

Paid company outings and lunches

Job summary

A leading healthcare management firm is seeking a Compliance Coding Auditor to support its Compliance & Ethics Program. The role involves auditing and monitoring compliance in healthcare practices, ensuring accurate coding and billing processes. Candidates should have 5-10 years of relevant experience in healthcare along with necessary certifications. The position offers comprehensive benefits including a full employer-paid HMO, generous PTO, and tuition reimbursement.

Qualifications

• Five to ten years of relevant professional experience in healthcare.
• Experience auditing healthcare claims in a large healthcare provider organization.
• Demonstrated ability to work effectively with stakeholders.

Responsibilities

• Perform internal compliance audits of documentation and coding.
• Prepare and present audit findings to stakeholders.
• Collaborate on corrective action plans to address compliance issues.

Skills

Healthcare auditing

Collaboration

Risk awareness

Documentation accuracy

Integrity

Education

Undergraduate degree in Health Business or related field

Coding certification (CPC or CRC)

Top-tier healthcare audit certification (CPMA)

Job description

Join to apply for the Compliance Coding Auditor , ATM role at Advanced Medical Management, Inc.

Your actual pay will be based on your skills and experience. Talk with your recruiter to learn more.

Base pay range: $75,000 to $80,000 per year.

Role Overview

As a member of AMM’s Compliance and Ethics team, the Compliance Coding Auditor is an important driver of our mission. They are responsible for supporting the Company’s Compliance & Ethics Program (the Program) auditing, tracking, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM’s key stakeholders, including patients, families, and government agencies. The Program is led by AMM’s Chief Compliance & Ethics Officer, who reports to the CEO and the Board, and oversees the AMM Compliance Committee.

This role requires sound, risk‑aware judgment, productive collaboration across the Company, and demonstrated success in performing audits to determine the integrity of billing and risk‑adjustment metrics, including appropriate documentation, accurate coding and billing, and medical necessity of billed services.

Essential Duties & Responsibilities

General Responsibilities

• Ensure that the Manager is timely informed of all key findings of internal compliance tests, assessments, audits, and monitoring initiatives.
• Remain informed of relevant developments and trends in healthcare compliance and ethics by attending seminars, reviewing professional journals, and actively participating in professional organizations, leveraging that insight to enhance the Program.

Auditing, Testing, and Monitoring Specific Responsibilities

• Perform internal compliance department audits to determine accuracy and adequacy of documentation and coding related to physician‑billed services based on supporting record documentation, ensuring documentation conforms to legal and procedural requirements.
• Prepare written reports of audit findings with recommendations, present to the Manager for review, and present to appropriate stakeholders; maintain audit records.
• Perform focused audits as needed in response to reported compliance and ethics concerns, with direction from the Manager of Auditing, Testing, and Monitoring.
• Ensure that written evaluative reports of findings are developed for all initiatives undertaken.
• Collaborate with the appropriate business unit leader to support corrective action plans to address systemic issues or pervasive practices that could give rise to potential violations of applicable laws, regulations, or AMM’s Code of Conduct and/or policies and procedures.
• Other duties as assigned.

Education & Experience

• Five to ten years of relevant professional experience in healthcare, including coding and/or auditing roles.
• Experience auditing healthcare claims in a professional services firm and/or in‑house at a large healthcare provider organization, health system, and/or payer.
• An undergraduate degree; preference for Health Business or related field.
• Alternatively, a high‑school diploma/GED plus five additional years of relevant experience.
• Required coding certification; preferred Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) from the American Academy of Professional Coders (AAPC).
• Required top‑tier healthcare audit certification; preferred Certified Professional Medical Auditor (CPMA) from the AAPC, along with a fundamental understanding of regulatory framework and coding practices.
• Fundamental understanding of government healthcare programs (i.e., Medicare and Medicaid).
• Demonstrated ability to work effectively with key internal and external stakeholders.

Professional Skills

• Ability to cultivate working relationships with government agencies.
• Ability to operate successfully in a flat culture, with courage and competence to engage on multiple fronts.
• Ability to prioritize effectively and exercise sound judgment in a fast‑paced, physician‑driven environment.
• Ability to accurately apply professional standards and government agency expectations for conducting healthcare auditing, testing, and monitoring activities.

Personal Characteristics

• Exemplary integrity with courage and an unwavering ethical compass.
• Pragmatic, risk‑aware professional judgment.
• Demonstrated tact, trustworthiness, and diplomacy skills needed to manage sensitive and confidential information.
• An adept listener with humility.
• Capable of earning the respect and confidence of colleagues through professional excellence and expertise.
• Prompt and efficient ability to manage shifting priorities, demands, and timelines.
• Ability to effectively prioritize and execute tasks in a fast‑paced, dynamic environment.

Benefits

• Full employer‑paid HMO with option for a flexible PPO plan.
• Discounted vision and dental premiums to support health and well‑being.
• Flexible Spending Accounts (FSAs) to manage healthcare and dependent care costs, plus a 401(k) for future security.
• Generous PTO, 40 hours of sick pay, and 13 paid holidays for work‑life balance.
• Tuition reimbursement to support education and growth.
• Paid company outings and lunches for team bonding.