Healthcare Compliance Auditor: Coding & Regulations Expert

CO010 Memorial Healthcare System; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Memorial Healthcare System is seeking an experienced audit professional to lead reviews of physician evaluation and management and procedure coding to ensure compliance with official guidelines and medical necessity.

You will prepare formal audit reports for executives, participate in investigations, monitor regulatory compliance, and validate documentation supporting coding decisions across MPG physicians. A strong background in AHIMA/AAPC certifications and CMS disclosures is preferred.

Qualifications

• Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
• Associates degree in Health Information Management, Health Information Technology, Health Informatics, or related field.
• AHIMA CCA and/or AAPC CPC/CPMA/HCC/CRC certifications.
• Knowledge of ICD-10 coding guidelines, medical necessity and regulatory compliance.

Responsibilities

• Prepare formal audit report of background, steps and findings for executive leadership and the Board of Commissioners.
• Participates in investigations and responds to questions, issues, reports by federal and state agencies.
• Monitor and assess compliance with laws and System policies to identify deviations and recommend corrective action.
• Follow up on audit findings to ensure corrective action plans are effective.
• Ensure compliance with regulatory agencies governing healthcare delivery and payers.
• Communicate with and educate employees on the Memorial Healthcare System Compliance Program.
• Audit medical records to verify documentation supports medical necessity and code accuracy.
• Review MPG physician coding and billing for E/M visits and procedures.
• Research CMS disclosures for financial relationships and verify disclosures on COI questionnaires.

Skills

Accountability

Analysis & decision making

Customer service

Effective communication

Healthcare industry

Problem solving

Responding to change

Standards of behavior

Education

Associates degree in Health Information Management

CCA - AHIMA

CPMA - AAPC

CPC - AAPC

HCC - AAPC

CRC - AAPC

Bachelor’s degree preferred

Job description

Memorial Healthcare System is seeking an experienced audit professional to lead reviews of physician evaluation and management and procedure coding to ensure compliance with official guidelines and medical necessity.

You will prepare formal audit reports for executives, participate in investigations, monitor regulatory compliance, and validate documentation supporting coding decisions across MPG physicians. A strong background in AHIMA/AAPC certifications and CMS disclosures is preferred.