Compliance Auditor - Billing

Job Details Compliance Auditor Job Description JOB SUMMARY Under general supervision, performs risk-based audits of clinical documentation, coding, and billing records to ensure that documentation supports services billed and complies with applicable regulatory and organizational requirements. This position independently validates documentation and coding compliance, identifies areas of compliance risk, and supports internal audit activities and external audit readiness across hospital-and provider-based settings. This role is outcome-driven and requires the ability to independently manage audit workload, documentation, and deadlines. ESSENTIAL FUNCTIONS • Performs risk-based audits of clinical documentation, physician, technical, and specialty billing and payment records by analyzing medical records, coding records, and health system bills to validate that documentation supports services billed and complies with applicable regulations and guidelines. • Evaluates the accuracy and appropriateness of coding, billing, and documentation practices, including assessment of medical necessity, level of service, and adherence to federal, state, and payer specific requirements. • Conducts audits across professional fee, hospital, and specialty services, including inpatient, outpatient, procedural, and ancillary services, as applicable. • Identifies patterns, trends, and outliers in documentation and coding practices and escalates identified compliance risks through appropriate compliance governance channels. • Utilizes audit findings, internal data, and regulatory focus areas to support the development and execution of risk-based audit plans aligned with organizational priorities. • Supports responses to external audit requests (e.g., government, payer, and regulatory reviews) through documentation review, validation, and compliance risk assessment. • Conducts targeted internal reviews in response to external audit findings or identified areas of compliance risk. • Maintains complete, accurate, and defensible audit workpapers supporting audit conclusions and quality assurance review. Prepares clear, concise audit reports summarizing findings, risk areas, and recommendations for Compliance leadership and stakeholders. • Works collaboratively with appropriate personnel, including Revenue Cycle, Coding, and operational teams, to support compliance objectives while maintaining independent audit judgment. • Communicates audit findings and identified risk area to