Professional Fee Compliance Auditor and Educator

University of Maryland Medical System Corporation; Linthicum (MD); On-site; USD 4,601,000 - 6,888,000; Full time

Job summary

University of Maryland Medical System Corporation is seeking a Compliance Coding Auditor to ensure documentation, coding, and billing align with CMS and policy guidelines. The role includes audits, education, and cross-functional collaboration with providers and administrators.

The candidate will use MDaudit to monitor coding patterns, present findings, and support system-wide compliance training. A CPC and 5+ years in coding with auditing experience are required.

Qualifications

• High school diploma.
• Five years of coding experience with two years auditing/billing compliance.
• Certified Professional Coder (CPC).
• Knowledge of CPT, ICD-10 and HCPCS coding and modifiers.
• Knowledge of healthcare regulatory/compliance issues.
• Experience with compliance auditing tools (e.g., MDaudit).
• Ability to maintain confidentiality and work with minimal supervision.

Responsibilities

• Conduct independent compliance audits of medical record documentation to support codes.
• Verify CMS guidelines and internal coding/billing policies through audits.
• Assist with reporting results, tracking regulatory updates, and providing training materials.
• Perform audits using MDaudit software and analyze patterns for risk mitigation.
• Present findings to providers, groups, and practice admins; develop corrective actions.
• Create training materials and system-wide education on compliance and coding.
• Prepare reports for executives and compliance committees.
• Monitor regulatory updates and document inquiries in the case management system.

Skills

CPC certification

CPT/ICD-10/HCPCS knowledge

Auditing & compliance

Regulatory research

Documentation & coding quality

MS Office

Education

High school diploma

Tools

MDaudit

Microsoft Office Suite

Job description

Job Requirements

Responsible for ensuring that all aspects of documentation, coding, and billing practices are in compliance with applicable laws, regulations, guidelines, and UMMS policies and procedures. Conduct audits to identify areas of non-compliance, assess risks, and collaborate with key stakeholders to monitor corrective measures when indicated. Responsible for validating that data abstracted from the electronic health record (EHR) is coded according to ICD-10-CM, CPT, HCPCS, AMA CPT guidelines, E/M guidelines, and CMS standards. Work is performed under limited supervision. Direct report to the Manager, Coding Compliance Training.

• Conduct independent compliance audits and review on the adequacy of medical record documentation to support the codes selected by providers and/or coders.
• Verify compliance with CMS guidelines, CPT, HCPCS, and ICD-10 standardized code sets, and internal coding and billing policies via documentation and coding review audits.
• Assist with reporting audit results, trending and tracking regulatory updates, responding to compliance inquiries, preparing education materials, and providing compliance educational support and training to providers and/or coders.
• Perform compliance documentation and coding audits using department’s MDaudit software.
• Analyze documentation and/or coding patterns by a provider, division, or department that poses a compliance risk and provide recommendations to mitigate risks.
• Present audit findings and recommendations to key stakeholders including but not limited to individual providers, provider groups, and practice administrators.
• Develop and administer training and educational materials to address documentation and coding deficiencies identified in audits; support the development and administration of system-wide compliance education (e.g., New Provider Compliance Education and Annual Compliance Education).
• Prepare reports for the Chief Compliance, Audit and Provider Officer, Vice President, Compliance Operations, Director, Revenue Cycle Billing and Coding Compliance, Manager, Coding Compliance and Training, UMMS Executive Management and the Audit and Compliance Committee of the Board of Directors.
• Conduct regulatory research, prepare draft responses to compliance inquiries for providers, administrators, and management.
• Monitor, track, and report regulatory updates regarding government billing and coding regulations.
• Log compliance incidents, inquiries, and investigations and supporting documentation in department’s case management system; complete assigned cases.
• Support compliance investigations.
• Draft policies, standard operating procedures, and prepare tools (e.g., toolkits, checklists).
• Meet department key performance indicators including but not limited to case turnaround time, audit productivity, and quality metrics.
• Perform other duties as assigned.

Work Experience

• High school diploma.
• Five (5) years’ experience in coding including two (2) years of auditing/billing compliance experience.
• Certified Professional Coder (CPC) certification.
• Working knowledge of CPT, ICD-10 and HCPCS coding and modifiers for appropriate reporting of patient services.
• Working knowledge of healthcare regulatory and compliance issues.
• Working knowledge of compliance auditing and monitoring techniques related to documentation and coding.
• Working knowledge of compliance audit software (e.g., MDaudit) or similar software.
• Ability to maintain confidentiality of all compliance related or other reported issues.
• Keen sense of personal responsibility and accountability for delivering high quality work.
• Effective analytical, critical thinking, planning, organizational, and problem-solving skills.
• Ability to work independently and in a team environment, with strong collaboration skills.
• Ability to analyze, compare, contrast, and validate work with keen attention to detail.
• Self-motivated individual who can excel with little supervision and has the ability to be successful in a fast paced, dynamic environment.
• Ability to evaluate the scope of each day’s work and use time management and organizational skills to complete assignments in a timely manner.
• Effective skill in the use of Microsoft Office Suite (e.g., Word, Excel, PowerPoint).
• Effective verbal, written, and interpersonal communication skills.

Benefits

All your information will be kept confidential according to EEO guidelines.

Compensation

• Pay Range: $33.40- $50.13
• Other Compensation (if applicable):
• Review the 2025-2026 UMMS Benefits Guide