Compliance specialist [h1.location_city]

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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

Knowledge, Skills and Abilities

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.