Senior Compliance Coding Auditor

Job description

Senior Compliance Coding Auditor - System Compliance

_Bring your passion to Texas Health so we are Better + Together_

Work Location: Texas Health Corporate, 612 E.

Lamar Blvd., Arlington, TX 76011

Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)

Department Highlights:

+ Hybrid Position
+ Gain a sense of accomplishment by contributing to a teamwork environment.
+ Receive excellent mentorship, comprehensive training, and dedicated leadership resources.

What You Will Do:

Team Oversight and Leadership
Provide direction and oversight to the compliance coding audit team, fostering collaboration and ensuring high-quality audit outcomes.
Oversee the creation, revision and distribution of policies, procedures and work instructions related to coding compliance.
Conduct prospective and retrospective chart reviews (ad hoc, work plan, monitoring, focused), comparing medical record documentation to reported CPT/HCPCS and ICD codes, while ensuring alignment with payer-specific coding requirements.
Validate that corrective actions have been implemented effectively.
Skilled in identifying discrepancies, validating documentation accuracy, and driving compliance with regulatory standards.
Recognizes and assess non-compliant activities, identifying gaps in regulations, coding standards, or documentation requirements and provide targeted recommendations for corrective actions, ensuring adherence to industry guidelines.
Delivers clear and comprehensive audit results to auditees, providers and/or ancillary staff.

Share actionable improvement strategies to enhance compliance and accuracy and provide education and guidance, ensuring alignment with regulatory and payer requirements.
Prepare detailed, structured, and data driven audit reports for leadership and auditees.

Ensure reports offer clear and actionable recommendations for improvement.
Other duties as assigned.
50%
Regulatory Monitoring and Integration
Monitor regulatory updates and evolving best practices in healthcare compliance.

Integrate new guidelines into auditing processes and educate stakeholders on emerging expectations.
Participate in external regulatory audits, including Medicare, OIG, and non- Medicare denial reviews.

Provide expert coding and documentation feedback to support compliance efforts.
40%

Additional Essential Functions
Assist with internal investigations and external regulatory inquiries(e.g., OIG, CMS) by providing coding expertise , documentation analysis and audit findings.
Partner with Clinical Documentation Improvement teams to enhance documentation quality and ensure diagnoses are accurately reflected and supported in the medical record.
Evaluate operational and revenue cycle activities to identify potential areas of fraud, waste and abuse.

Recommend corrective actions and escalate concerns as needed.
Contribute to the development of the annual audit workplan by identifying high-risk areas and aligning audit priorities.
Deliver formal and informal training sessions to providers and coding staff on documentation standards, coding accuracy and regulatory updates.

10%

What You Need:

Education
Bachelor's Degree 6 Years Req

Experience
6 Years Experience in medical coding (inpatient, outpatient and evaluation and management coding).

Proven experience in conducting coding audits (prospective, retrospective, focused and monitoring.

Req

Licenses and Certifications
RHIT - Registered Health Information Technician Upon Hire Req Or
RHIA - Registered Health Information Administrator Upon Hire Req Or
CCS - Certified Coding Specialist Upon Hire Req Or
CPC - Certified Professional Coder Upon Hire Req

**Education** Bachelor's Degree 6 Years Req **Experience** 6 Years Experience in medical coding (inpatient, outpatient and evaluation and management coding).

Proven experience in conducting coding audits (prospective, retrospective, focused and monitoring.

Req **Licenses and Certifications** RHIT - Registered Health Information Technician Upon Hire Req Or
RHIA - Registered Health Information Administrator Upon Hire Req Or
CCS - Certified Coding Specialist Upon Hire Req Or
CPC - Certified Professional Coder Upon Hire Req **Skills** Excellent organizational and time management skills.

Driven to simultaneously handle multiple projects, prioritize, and meet deadlines.
Consistently upholds high ethical standards and demonstrates integrity in professional responsibilities.

Ensures compliance with regulations, promotes transparency, and fosters trust in all interactions with colleagues, leadership, and stakeholders.
Demonstrates meticulous attention to detail and commitment to producing high-quality work.

Possesses strong critical thinking abilities, with the initiative to identify solutions, drive improvements and ensure accuracy to complex tasks.
Experienced medical coding auditor with advanced proficiency in ICD-10-CM/PCS, CPT, HCPCS coding, modifiers, NCCI edits, official coding guidelines.

Skilled in Microsoft Office (Excel, Word, PowerPoint) to streamline audits and reporting.

Excellent verbal and written communication skills, with a proven ability to provide clear guidance and collaborative effectively across teams.
Committed to accurate documentation that reflects patient health status while driving education and process improvement.
Expertise in auditing, delivering constructive feedback to coders, non-coders, and senior leadership, and translating complex coding rules into clear, actionable insights.
Skilled in data analysis, summarizing findings, leading meetings, training others, and applying independent judgment to ensure compliance and accuracy.
Skilled in research, and compliance interpretation, with expertise in Medicare, OIG, CMS, and other regulatory standards.

**Supervision** Individual Contributor **ADA Requirements** Extreme Heat 1-33%
Extreme Cold 1-33%
Extreme Swings in Temperature 1-33%
Extreme Noise 1-33%
Working Outdoors 1-33%
Working Indoors 67% or more
Mechanical Hazards 1-33%
Electrical Hazards 1-33%
Explosive Hazards 1-33%
Fume/Odor Hazards 1-33%
Dust/Mites Hazards 1-33%
Chemical Hazards 1-33%
Toxic Waste Hazards 1-33%
Radiation Hazards 1-33%
Wet Hazards 1-33%
Heights 1-33%
Other Conditions 1-33% **Physical Demands** Sedentary
Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Required Skill Profession

Other General