Pennsylvania Licensed Compliance Auditor

Job Summary

A company is looking for a Compliance Auditor (medical coding and billing).

Key Responsibilities

• Perform compliance audits on medical record documentation, billing, and coding to evaluate compliance risks and recommend solutions
• Identify training needs from audit results and educate physicians and non-physician practitioners accordingly
• Analyze evidentiary data to assess the effectiveness of systems and recommend improvements based on audit findings

Required Qualifications, Training, and Education

• High School Diploma or Equivalent (GED) required
• Minimum of 6 years of relevant experience required
• At least one coding certification required (e.g., Certified Professional Coder, Certified Risk Adjustment Coder, Registered Health Information Technician)
• Expert knowledge of State and Federal healthcare program regulations
• Experience in compliance auditing and risk assessment processes