HIM Audit Specialist - Compliance & Coding

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

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