Compliance Billing & Coding Auditor

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Job Summary
The Healthcare Compliance Billing & Coding Auditor is responsible for performing independent audits of billing and coding practices across hospital departments and clinic providers to ensure compliance with organizational policies, federal and state regulations, and payer requirements.

Reports to
Chief Compliance Officer

Job Specific Responsibilities
1. Conduct comprehensive audits of billing and coding documentation for accuracy and compliance in both hospital and clinic settings.
2. Identify discrepancies, potential compliance risks, and recommend corrective actions.
3. Develop audit reports and present findings to leadership.
4. Stay current with regulatory changes, coding guidelines (ICD-10, CPT, HCPCS), and compliance standards.
5. Collaborate with clinical and administrative teams to implement best practices.
6. Assist in compliance training related to billing and coding.
7. Perform additional compliance and research-related responsibilities as needed to support organizational objectives.

Education and Experience
• Associate’s degree in Health Information Management, Nursing or related field.
• Preferred: Bachelor’s degree.
• +3 years of experience in hospital and clinic compliance, billing, and coding audits
• Strong knowledge of CMS regulations, HIPAA, and payer guidelines.

Required Licensures/Certifications/Registrations
• CPC, CCS, or equivalent coding certification required.
• Must obtain Certified Professional Medical Auditor (CPMA) from AAPC, which demonstrates expertise in auditing, compliance, and risk-based methodologies, within 12 months of hire date.

Knowledge, Skills and Abilities
• Experience with electronic health records (EHR) and audit software (i.e. Cerner, EPIC, Healthicity, Nektar).
• Able to work independently and manage multiple audits simultaneously.
• Excellent communication and reporting skills.
• Ability to work autonomously while collaborating with compliance and revenue cycle teams.

Interaction with Other Departments and Other Relationships
This position will work with all departments throughout UMC and interact with external agencies, vendors, and research partners.

Physical Capabilities
Visual and auditory acuity are required continuously. Ability to speak is required frequently. Sitting, walking, and standing for extended periods of time may be required.

Environmental/Working Conditions
This position is subject to inside environmental changes that may include constant change in temperatures.

Direct Reports
N/A

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

*Request for accommodations in the hire process should be directed to UMC Human Resources.​*