HIM Audit Clerk

Southwell, Inc.; Tifton (GA); On-site; USD 55,000 - 75,000; Full time

Job summary

Southwell, Inc. Health Information Management department is seeking a full-time HIM Audit Clerk to support internal and external audit activities related to medical record documentation, coding, and billing compliance.

The role oversees audits such as TPE, CERT/CDR, CLDR, and other payer or regulatory audits, ensuring timely, accurate, and compliant audit responses. The position collaborates with coding, billing, CDI, providers, and clinical staff to resolve audit findings, maintain

Qualifications

• Experience coordinating audits (TPE, CERT/CDR, CLDR, RAC, MAC, commercial payer) and responding within deadlines.
• Review medical records to ensure documentation supports billed services, diagnoses, and procedures.
• Maintain HIPAA compliance and confidentiality.

Responsibilities

• Manage audit requests including TPE, CDR/CERT, CLDR, RAC, MAC, and internal audits.
• Review medical records to ensure documentation supports billed services, diagnoses, and procedures.
• Perform pre-submission and post-submission audits for coding and billing accuracy.
• Validate physician documentation for completeness, signatures, and regulatory compliance.
• Prepare and submit audit responses within required timeframes.
• Track audit requests, submissions, outcomes, and trends using audit logs or tracking tools.

Education

Associate's Degree

Job description

DEPARTMENT: HEALTH INFORMATION MANAGEMENT

F ACILITY: Medical Office Building

WORK TYPE: Full Time

S HIFT: Daytime

SUMMARY

The HIM Audit Clerk is responsible for supporting internal and external audit activities related to medical record documentation, coding, and billing compliance. This role plays a key part in responding to and managing audits such as Targeted Probe and Educate (TPE), Comprehensive Error Rate Testing (CERT/CDR), Clinical Laboratory Documentation Reviews (CLDR), and other payer or regulatory audits. The position requires a strong understanding of coding, billing, and medical record documentation standards to ensure timely, accurate, and compliant audit responses.

RESPONSIBILITIES

• Manage and coordinate audit requests including TPE, CDR/CERT, CLDR, RAC, MAC, commercial payer, and internal audits
• Review medical records to ensure documentation supports billed services, diagnoses, and procedures
• Perform pre-submission and post-submission audits for coding and billing accuracy
• Validate physician documentation for completeness, signatures, and compliance with regulatory requirements
• Collaborate with coding, billing, CDI, providers, and clinical staff to resolve audit findings
• Prepare and submit audit responses within required timeframes
• Track audit requests, submissions, outcomes, and trends using audit logs or tracking tools
• Identify patterns or recurring issues and report findings to HIM leadership
• Assist with education and feedback for providers and staff based on audit results
• Ensure audit documentation is properly indexed and maintained in the electronic health record
• Maintain knowledge of CMS, payer guidelines, and regulatory requirements related to audits
• Support process improvement initiatives related to documentation, coding accuracy, and compliance
• Maintain confidentiality and compliance with HIPAA and organizational policies
• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. (“TRHS”) policies as they presently exist and as they change or are modified.
• Understands and adheres to: TRHS’ compliance standards as they appear in TRHS’s Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.

EDUCATION

• Associate's Degree

CREDENTIALS

• REGISTERED HEALTH INFORMATION TECHNOLOGIST
• REGISTERED HEALTH INFORMATION ADMINISTRATOR
• Certified Coding Specialist
• Certified Professional Coder
• Certified Professional Medical Auditor

OTHER INFORMATION

Associate degree in health information management or related field required.

Must maintain at least one of the following credentials: RHIT, RHIA, CCS, CPC, CPMA or equivalent

Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.