Introduction
The Compliance Auditor plays a vital role in ensuring that healthcare organizations maintain accurate documentation, coding, and billing practices. As a Compliance Auditor, you will help develop, implement, and manage a strong compliance program within the Revenue Management Compliance department. This role involves auditing, evaluating, and improving healthcare documentation to ensure full adherence to state and federal regulations. You will support physicians, practitioners, and leadership by providing insights, training, and recommendations that enhance compliance and protect the organization from potential risks.
Key Responsibilities of a Compliance Auditor
The Compliance Auditor will conduct detailed audits to assess the accuracy of medical documentation, billing, and coding practices. This includes evaluating compliance with hospital and professional standards, as well as state and federal laws. You will identify potential compliance risks, recommend corrective actions, and collaborate with cross-functional teams to ensure consistent adherence to policies and procedures.
Additionally, the Compliance Auditor will analyze audit data, identify areas for improvement, and contribute to developing educational materials for medical staff. The position requires strong analytical skills, knowledge of healthcare regulations, and the ability to provide clear, actionable insights.
Core Duties and Expectations of a Compliance Auditor
As a Compliance Auditor, you will be responsible for:
- Performing detailed audits of documentation, billing, and coding in line with federal and state laws.
- Evaluating compliance risks and providing strategic recommendations for improvement.
- Identifying and addressing training needs by collaborating with peers and educating physicians and practitioners.
- Acting as a subject matter expert in clinical coding and healthcare regulations.
- Working with the revenue cycle team to ensure compliance with established systems and workflows.
- Defining audit scope, evaluating control points, and reviewing corrective actions following internal or external audits.
- Preparing comprehensive audit summaries and executive briefs highlighting findings and solutions.
- Contributing to risk assessment processes to guide compliance improvement initiatives.
Qualifications for the Compliance Auditor Role
To qualify for the Compliance Auditor position, candidates must have:
- A High School Diploma or GED (required).
- A minimum of six years of relevant experience in compliance auditing or healthcare coding.
- At least one coding certification such as:
- Certified Professional Coder (CPC) – AAPC
- Certified Risk Adjustment Coder (CRC) – AAPC
- Registered Health Information Technician (RHIT) – AHIMA
Work is primarily office-based, requiring attention to detail, strong organizational skills, and adherence to compliance policies. Equivalent experience may be substituted for educational requirements where applicable.
Our Values and Work Culture
At our organization, the Compliance Auditor is part of a team dedicated to kindness, excellence, learning, innovation, and safety. We provide a collaborative environment that encourages growth, continuous improvement, and diversity. From management to frontline staff, we believe in teamwork and integrity. Employees enjoy comprehensive benefits from day one, including health, vision, and dental coverage for both full-time and part-time roles.
We are proud to be an equal-opportunity employer committed to creating an inclusive workplace for individuals of all backgrounds.
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