Healthcare Compliance Auditor — Billing & Coding

Covenant Health; Tennessee; On-site; USD 70,000 - 95,000; Full time

Job summary

Covenant Health in East Tennessee is seeking a qualified internal auditor to perform complex compliance audits across charging, coding, documentation and billing processes within our system. The role reports to the Compliance Audit Manager and works with physicians, clinical management, and staff to mitigate risk.

The successful candidate will review Medicare/Medicaid guidelines, stay current on payer rules, and coordinate with various departments to resolve overpayments, document findings, and

Qualifications

• Three to five years of healthcare experience.
• Strong knowledge of healthcare billing and payor rules.
• Experience with problem solving and analytical reviews.
• Proficiency with PCs, Windows, Excel and Word.
• Excellent public relations skills.

Responsibilities

• Identify and evaluate risk areas and provide auditing procedures related to documentation, coding and billing.
• Review regulatory publications and stay current with coding and reimbursement guidelines.
• Analyze charges, CPT coding and modifiers to ensure compliance.
• Coordinate with teams to address over/under payments identified during audits.
• Communicate audit results via reports and presentations to physicians and management.
• Document audit activities and report statistics per policy.
• Assist with special projects and collaborate with HIM, patient accounting, IS staff.
• Review ongoing activities in baseline and periodic audits under leadership.
• Advise facility leaders and staff on audit findings and process improvements.
• Maintain communication with facilities to improve customer service.
• Promote teamwork to achieve goals with accuracy and professionalism.
• Follow policies, complete required education, and participate in quality initiatives.
• Performs other duties as assigned.

Skills

Healthcare billing

Medicare/Medicaid guidelines

Analytical reviews

Regulatory compliance

Microsoft Excel

Word processing

Public relations

RHIT/RHIA/CCS/CPC

Job description

Covenant Health in East Tennessee is seeking a qualified internal auditor to perform complex compliance audits across charging, coding, documentation and billing processes within our system. The role reports to the Compliance Audit Manager and works with physicians, clinical management, and staff to mitigate risk.

The successful candidate will review Medicare/Medicaid guidelines, stay current on payer rules, and coordinate with various departments to resolve overpayments, document findings, and