Healthcare Coding & Billing Compliance Auditor

Cape Cod Healthcare; Hyannis (MA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Healthcare benefits

Dental benefits

Vision benefits

Retirement plan

Job summary

Cape Cod Healthcare is seeking a Coding and Billing Compliance Auditor to ensure accuracy, integrity, and regulatory compliance of clinical documentation, coding, and billing across the health system. The role conducts audits, identifies discrepancies, and educates staff to reduce risk and optimize reimbursement.

You'll collaborate with Revenue Cycle, HIM, CDI, and Compliance teams, prepare audit reports, and present findings to leadership, driving continuous improvement in coding standards and

Qualifications

• Bachelor’s degree in Healthcare, Compliance, Finance, Business or Accounting.
• Minimum of five years’ experience in physician coding, including auditing.
• Current CPC or CCS-P certification.
• Preferred CPMA or E/M CEMC certification.
• Knowledge of ICD-9/ICD-10, CPT, and physician billing.
• Proficient with EHR and billing systems; able to train others.

Responsibilities

• Conduct audits of medical records, coding and billing for accuracy and compliance.
• Evaluate claims for ICD-10, CPT, HCPCS coding accuracy and discrepancies.
• Perform scheduled and impromptu audits of documentation to verify codes.
• Monitor adherence to internal policies and regulatory changes.
• Assist with risk assessments and internal investigations related to billing.
• Prepare comprehensive audit reports and track corrective actions.
• Present findings to leadership and promote compliance across teams.
• Provide education to coders, billers and staff on coding requirements.
• Develop training programs on coding standards and updates.
• Collaborate with Revenue Cycle, HIM, CDI and Compliance teams.
• Support external audits and respond to payer or government inquiries.

Skills

Auditing experience

Coding accuracy

Regulatory knowledge

Communication

Training delivery

EHR software

Education

Bachelor's degree (Healthcare/Compliance)

CPC / CCS-P certification

Tools

EHR systems

Billing software

Audit software

Job description

Cape Cod Healthcare is seeking a Coding and Billing Compliance Auditor to ensure accuracy, integrity, and regulatory compliance of clinical documentation, coding, and billing across the health system. The role conducts audits, identifies discrepancies, and educates staff to reduce risk and optimize reimbursement.

You'll collaborate with Revenue Cycle, HIM, CDI, and Compliance teams, prepare audit reports, and present findings to leadership, driving continuous improvement in coding standards and