Medical Compliance Auditor – Billing & Coding

Lexington Medical Center; West Columbia (SC); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Day-one benefits

403(b) match

Life insurance

Disability coverage

Student loan forgiveness

Adoption assistance

Job summary

Lexington Health, a comprehensive network of care with multiple facilities in West Columbia, SC, seeks a Compliance Audit professional to analyze and audit hospital and Physician Network records to ensure charges are supported by appropriate medical documentation.

You will monitor risk, prepare reports, and meet with physicians and APPs to review findings while collaborating with Revenue Integrity and HIM to drive coding accuracy and regulatory compliance within the organization.

Qualifications

• Bachelor's degree in Business or related field.
• 3 years of directly related experience.
• CPMA or CPC/CCS certifications encouraged; CPMA within 1 year of entry date.

Responsibilities

• Audit hospital and Physician Network records to ensure services are documented and billed per Medicare/Medicaid/third-party regulations.
• Assist the Chief Compliance Officer in investigations related to billing and coding.
• Collaborate with Health Information Management and Revenue Integrity on coding reviews.
• Draft formal reports summarizing medical record findings for review with stakeholders.
• Educate LMC staff on coding and billing changes relevant to reviews.
• Verify medically necessary criteria per CMS and LCDs as applicable.

Skills

Problem solving

Communication skills

Microsoft Office

Education

Bachelor's Degree in Business or Related Field

3 Years of directly related experience

Tools

CPC Certification

CCS Certification

CPMA Certification (within 1 year)

Job description

Lexington Health, a comprehensive network of care with multiple facilities in West Columbia, SC, seeks a Compliance Audit professional to analyze and audit hospital and Physician Network records to ensure charges are supported by appropriate medical documentation.

You will monitor risk, prepare reports, and meet with physicians and APPs to review findings while collaborating with Revenue Integrity and HIM to drive coding accuracy and regulatory compliance within the organization.