Medical Group Compliance Auditor Senior

ID 2025-35238
Location
Cone Health
Work Location
US-NC-Greensboro
Division : Name
System Wide
Department : Name
SW-Corp Compliance Audit
Category
PROFESSIONAL/MNGMNT
Position Sub-Category
PROFESSIONAL/MNGMNT
Position Type
Full Time (40 hours/week)
Employment Type
Employee
Exempt/NonExempt
Exempt
FTE
1.00
Workforce Status
Hybrid I
Work Hours
40.00
Provider Schedule (specific schedule)
Monday-Friday 8:00 am - 5:00 pm
On call Required
No
Sub Category
Professional/Management

Overview

The Medical Group Compliance Auditor Senior is responsible for providing audit, coding support and guidance to physicians, APPs, residents and support staff. This role ensures that all coding, billing and documentation complies with federal and/or state regulations, private payer health care program requirements as well as the Compliance and Operations Policies of the organization. This job assists with the development and implementation of educational and training programs as well as coding tools and resources to help achieve organization?s goal of consistent, complete and accurate coding and documentation.

Responsibilities


Conducts regularly scheduled compliance reviews for assigned providers within designated time frames.
Performs Reviews clinical documentation to verify accuracy of CPT/HCPSC and ICD.10 codes and modifier assignments.
Provides written report of findings to the provider and select administrative personnel along with recommendations for improvement.
Monitors regulatory and reimbursement information to keep informed of relevant changes and updates.
Performs special demand audits as requested or noted in compliance or audit work plans program.
Educates providers one-on-one or in a group setting based on need or as a result of an audit.
Provides oversight and quality assessment of audit and other work of Medical Group Compliance Auditors as well as peers.
Maintains effective communication with department staff as well as key stakeholders and consistently demonstrates high standards of professional conduct and ethics, as well as appropriate judgment, independence, and discretion.
Performs other duties as assigned.

Qualifications


EDUCATION:
Required: High School Diploma or equivalent

EXPERIENCE:
Required: 5 years

LICENSURE/CERTIFICATION/REGISTRY/LISTING:
Required: One of the following: Certified Professional Coder (CPC) or Certified Coding Specialist (Physician-based) (CCS-P).
Preferred: Any additional certifications such as Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA).

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