Compliance Auditor

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

📋 Description

• Review service documentation to ensure it is complete, accurate, and compliant with payer requirements.

• Utilize auditing software tools to perform audits, document results, and facilitate audit activities.

• Work in conjunction with internal audit personnel on collaborative projects and pinpoint opportunities to enhance audit processes.

• Provide education to providers on audit results and convey findings in a clear, concise, and accurate manner.

• Examine irregularities detected during audit processes and escalate findings for further examination.

• Implement program-specific regulatory guidelines and dual-program audit protocols.

• Execute audit tasks in line with established efficiency benchmarks and expectations set by Audit Services leadership.

• Meet with Compliance and Audit leadership to review findings, processes, priorities, and potential improvements.

• Assess the impact of clinical and operational changes on audit procedures and propose or execute risk-mitigation strategies.

• Engage in the review and resolution of claim rejections and reimbursement inconsistencies alongside Patient Accounting.

• Track documentation trends and report any deficiencies and compliance issues.

• Conduct follow-up education on clinical documentation improvement based on audit outcomes.

• Analyze medical codes using ICD-10 and CPT to evaluate coding precision and compliance.

• Extract and assess reports from electronic health record (EHR) systems for auditing, monitoring, and reporting purposes.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• High School diploma or GED is required.

• A minimum of one (1) year of experience with medical terminology is preferred.

• Experience collaborating with diverse groups in a healthcare setting is essential.

• Familiarity with government healthcare reimbursement systems is necessary.

• Preferred experience with ICD, DSM V, and Excel.

• Must be detail-oriented and highly organized, capable of managing multiple priorities efficiently.

• Ability to work both independently and as part of a team to enhance processes and outcomes.

• Proficient in interpreting data and recognizing patterns that support compliance and operational enhancements.

• Must communicate clearly and professionally with both clinical and administrative teams.

• A strong commitment to accuracy, accountability, and continuous learning within a healthcare context is required.

🏝️ Benefits

• Comprehensive health coverage options.

• Opportunities for professional development and career growth.

• Supportive and inclusive work environment.