Coding & Compliance Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Deliver auditing, compliance, education, and consulting services to healthcare clients

• Perform documentation and coding reviews, regulatory research, and provider education

• Collaborate as part of an audit team to finalize client projects while adhering to productivity, quality, and deadline standards

• Access medical record documentation from client EMR/PM systems

• Evaluate medical records to ensure chart content and documentation requirements are met

• Utilize audit reporting tools to record results and prepare reports for quality assurance review and client delivery

• Interpret CMS, AMA, OIG, NCCI, and payer guidance for audit findings and compliance recommendations

• Identify trends in documentation, coding, billing, and risk, and communicate findings

• Prepare and present audit results, executive summaries, and compliance recommendations

• Develop reports on audit findings and corrective action plans

• Conduct education and training sessions for both internal team members and clients

• Provide education to providers on documentation and compliance matters

• Engage in quality assurance and peer review activities

• Assist with audit tools, educational resources, methodologies, and compliance materials

• Coordinate and research resources for client projects

• Support leadership in achieving timely, scope-compliant, and budget-friendly project delivery

• Aid in the development of project scope, objectives, and stakeholder engagement

• Build and maintain relationships with clients and stakeholders

• Review quality assurance reports and implement necessary corrections

• Stay updated on government regulatory guidance and payer requirements

• Maintain knowledge of healthcare auditing principles and compliance topics

⛳️ Requirements

• Experienced Ophthalmic Compliance Auditor

• A minimum of 5–10 years of hands-on experience in a practice setting as a skilled technician, scribe, or clinic manager, or at least 3 years in healthcare auditing, documentation review, compliance, or regulatory experience

• Proven experience in analyzing payer policies, regulatory guidance, and reimbursement requirements while translating findings into actionable recommendations

• Experience in presenting written reports to providers, executives, and/or compliance leadership

• Background in working independently in a consulting or client-service environment is preferred

• Strong familiarity with CPT, HCPCS, ICD-10, and Ophthalmology/Optometry-related codes and CMS guidelines

• Comprehensive understanding of and compliance with HIPAA regulations

• Acquainted with legal, regulatory, policy, and documentation compliance issues related to medical coding and billing procedures

• Specific expertise in ophthalmology is highly desirable

• Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, and healthcare reimbursement principles

• Capability to assess complex documentation scenarios and apply nuanced regulatory guidance

• Excellent written communication skills, including audit report writing, corrective action development, and executive-level communications

• Strong organizational, communication, analytical, problem-solving, and time management skills

• Ability to facilitate provider education

• Skill in identifying trends, interpreting data, and formulating practical, risk-based recommendations

• Demonstrated professionalism and executive presence with clients and stakeholders

• Willingness to collaborate with team members to reach consensus on billing and coding issues

• Flexible and collaborative approach to diverse tasks and customer types

• Commitment to high-quality, detail-oriented work

• Self-directed and motivated; capable of working independently, prioritizing responsibilities, and maintaining productivity remotely

• Tech-savvy and internet proficient; experience with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)

• JCAHPO certification (COA, COT, COMT) and/or CPC, CPMA, OCS, and/or COPC is desired

• Must be willing to obtain coding certification(s)

• COE certification is highly beneficial

• Preferred certifications include CPMA, CHC, CPCO, CRC, RHIA, RHIT, COC

🏝️ Benefits

• Fully remote work arrangement

• Some travel required