Healthcare Coding Compliance Auditor - RUHS

County of Riverside; California; Hybrid; USD 110,000 - 150,000; Full time

Job summary

County of Riverside seeks two Coding Compliance Auditors (Administrative Services Manager I) to lead auditing of inpatient and outpatient records for accurate ICD-10-CM/PCS, CPT, and HCPCS coding. The role requires extensive CMS/IPPS knowledge and experience with external audits.

You will collaborate across CDI, HIM, and Revenue Cycle teams, deliver education to providers and staff, and support program development with risk-based audits and performance improvements.

Qualifications

• Bachelor's degree in accounting, business or public administration or closely related field.
• Minimum of three years in admin/staff role with at least two years supervising professional/technical staff.
• Experience with inpatient/outpatient auditing, CMS regulations, and external audits preferred.
• Certifications CCS, CPC, RHIT/RHIA, CDIP or CPMA required.
• Experience with encoder/audit software (3M, Optum, EPIC) is strongly preferred.

Responsibilities

• Conduct comprehensive audits of inpatient and outpatient records for ICD-10-CM/PCS, CPT, HCPCS according to guidelines.
• Evaluate DRG assignment accuracy and POA indicators.
• Monitor compliance with Medicare/Medicaid and payer policies.
• Assess documentation for medical necessity and risks like upcoding/undercoding.
• Perform focused audits based on risk assessments and audit priorities.
• Collaborate with CDI, HIM, Revenue Cycle, and Case Management to resolve discrepancies.
• Prepare detailed audit reports with findings, root cause and corrective actions.
• Educate providers and staff on regulatory updates and audit findings.
• Track audit metrics and perform re-audits for sustained improvements.
• Support external audits (RAC, MAC, OIG, payers) as needed.
• Maintain knowledge of CMS transmittals and coding guidance.

Skills

MS-DRG reimbursement

Auditing/compliance

CMS IPPS/OPPS

OIG Work Plan

NCCI edits

Medical necessity rules

Encoder/audit software

Education

Bachelor's degree in accounting, business, or public administration

CCS

CPC

RHIT/RHIA

CDIP

CPMA

Tools

3M

Optum

EPIC

Job description

For questions regarding this position, please contact the Recruiter listed in the Supplemental Information section.

About The Position

Riverside University Health System (RUHS)is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health System's Compliance Department.

Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations, while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual, periodic, and focused audits of physician, inpatient, and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally, the role supports ongoing program development through training initiatives and process improvements, delivers coding presentations to diverse audiences including physicians and other staff.

The ideal candidate will have at least five years of progressive experience in an acute care hospital setting, including inpatient MS-DRG reimbursement, along with 3–5 years of coding audit or compliance auditing experience. This includes extensive expertise in inpatient and outpatient auditing (MS-DRGs, CC/MCC validation, POA indicators, PSI/HAC implications), managing external audits (RAC, MAC, OIG, UPIC, commercial payers), and strong knowledge of CMS IPPS/OPPS regulations, OIG Work Plan priorities, Medicare Conditions of Participation, Official Coding Guidelines, NCCI edits, and medical necessity rules. The candidate should have experience conducting risk assessments, developing audit work plans, quantifying financial impact, presenting findings to leadership, collaborating across CDI, HIM, Revenue Integrity, and Compliance teams, providing provider education, and supporting denials and appeals. Experience in large or multi-facility health systems, proficiency with encoder and audit software (e.g., 3M, Optum, EPIC) is strongly preferred.

Two years of supervisory experience is required as well as one of the following certifications: CCS, CPC, RHIT/RHIA, CDIP, or CPMA.

Work Schedule & Location:

• Schedule: 9/80 work schedule - hybrid
• Location: 7898 Mission Grove Parkway, Riverside

This class has been deemed eligible for the Performance Recognition Plan as set forth under Article 3, Section 311 of the County Management Resolution. Program eligibility requires employees to be in a leadership position, manage other employees or programs and have significant influence on the achievement of organizational objectives.

Meet the Team!

Every day at Riverside University Health System Medical Center, a dedicated team of healthcare professionals and support staff come together to improve lives across Riverside County. Our nationally recognized programs and specialized services thrive because of the diverse talents and commitment of our team members. No matter your background or skill set, you’ll discover meaningful opportunities and a strong sense of purpose here.

To learn more about RUHS Medical Center, please visit www.ruhealth.org

Examples Of Essential Duties

• Conduct comprehensive audits of inpatient and outpatient medical records to ensure accurate ICD-10-CM/PCS, CPT, and HCPCS coding in accordance with official coding guidelines and regulatory requirements.
• Evaluate DRG assignment accuracy and validate principal and secondary diagnoses, procedures, CC/MCC capture, and POA indicators.
• Monitor compliance with federal and state regulations, including Medicare, Medicaid, and commercial payer policies.
• Assess adherence to documentation standards and identify risk areas related to medical necessity, upcoding, undercoding, and unbundling.
• Perform focused audits based on risk assessments, OIG Work Plan priorities, denials trends, and internal compliance initiatives
• Collaborate with Clinical Documentation Integrity (CDI), Health Information Management (HIM), Revenue Cycle, and Case Management teams to resolve coding discrepancies and improve documentation quality.
• Prepare detailed audit reports outlining findings, root cause analysis, financial impact, and corrective action recommendations.
• Educate providers, coders, and revenue cycle staff on regulatory updates, coding changes, audit findings, and compliance risks.
• Track audit metrics, monitor corrective action plans, and perform re-audits to ensure sustained compliance improvements.
• Support internal investigations and respond to external audit requests (RAC, MAC, OIG, commercial payers).
• Maintain knowledge of CMS transmittals, coding clinic updates, and evolving regulatory guidance affecting acute care services.
• Contribute to enterprise-wide compliance risk assessments and annual compliance work plan development.

Minimum Qualifications

Education:

Graduation from an accredited college or university with a bachelor's degree, preferably with a major in accounting, business or public administration, information services, finance, or a closely related field to the assignment. (Additional qualifying experience may be substituted for the required education on the basis of one year of full-time experience equaling 30 semester or 45 quarter units of the required education.)

Experience:

Minimum of three years experience in an administrative or staff capacity which must have included at least two years of experience supervising professional and technical staff in two of the following areas: gathering and compiling facts and statistics to evaluate program effectiveness and recommend program revisions; preparing and maintaining a program budget or maintaining and controlling the fiscal record keeping functions and systems in a department, agency, division, unit or company; coordinating and conducting studies of administrative and operational activities including budget preparation and control, equipment usage, staff patterns, work flow and space utilization. (Possession of a Master's degree from an accredited college or university in accounting, business or public administration, finance, or a closely related field may substitute for up to two years of the required experience on the basis of 30 semester or 45 quarter units equaling one year of full-time experience.)

Certifications (required):

• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC)
• Registered Health Information Tech/Administrator (RHIT/RHIA)
• Certified Document Integrity Practitioner (CDIP)
• Certified Professional Medical Auditor (CPMA)

SUPPLEMENTAL INFORMATION

What’s Next?

This recruitment is open to all applicants. Applicants who are current County of Riverside employees and/or current employees of Riverside University Health System may be considered before other applicants, depending on the volume of applications received.

For Questions About This Recruitment, Please Contact

Angela Levinson

Email: [e-mail]

Phone: [phone]

APPLICATION INFORMATION

Veteran's Preference

The County has a Veterans Preference Policy applicable to new hires. To qualify, attach the required documents to your job application. Documents include a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service. For spousal preference, and as applicable, the following documents: a copy of your marriage certificate, spouse's death certificate, a letter of spouse's disability and/or letter of service-related death (if available) from the U.S. Veteran's Administration. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference. For complete details and documentation requirements, please review the Veterans Preference Policy, C-3 here: https://rivcocob.org/board-policies

Reasonable Accommodations

The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability

Work Location and Telework

In-person attendance is the standard work expectation for County of Riverside assignments. Certain assignments may be eligible for a hybrid telework schedule; however, telework arrangements are subject to management approval, operational needs, and/or may be modified or discontinued at any time. Employees who telework are expected to be able to report to their assigned worksite on short notice or as operational needs require. Unless otherwise specified for a particular position, employees are expected to reside in California following appointment. Limited exceptions may apply. Applicants should contact the assigned recruiter for additional information regarding work location expectations, telework eligibility, and residency requirements.

Proof of Education

If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).

Work Authorization Requirement

Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs, including H1-B visas, and will not provide sponsorship for any employment-based visas.

Equal Opportunity Employer

The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.

Pre-Employment

All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period

As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information

Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

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