Job Description

Job Description

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POSITION SUMMARY/RESPONSIBILITIES

Works to utilize the department’s resources for analytical auditing and monitoring activities related to University Health’s compliance program.  The position reports directly to the Chief Compliance/HIPAA Officer and plays a critical role in advancing the organization’s compliance program by contributing to the development and execution of the annual Compliance Work Plan. This position is responsible for conducting complex audits of medical coding, billing, and documentation practices to ensure adherence to federal and state regulatory standards, internal policies, and ethical guidelines. The position performs end-to-end reviews of clinical documentation, coding assignments, charge capture, and claim submissions, ensuring that coding is accurate, complete, and supported by the medical record. By evaluating operational and revenue cycle activities, the auditor identifies compliance risks, internal control deficiencies, and potential areas of fraud, waste, or abuse, offering recommendations for corrective action and process improvement.

In this role, the auditor serves as a subject matter expert in healthcare coding standards such as CPT, ICD-10-CM, and HCPCS, as well as CMS and OIG guidelines. The position requires drafting detailed audit reports, communicating findings to leadership, and confirming the implementation of corrective measures. The Integrity Manager also supports the Chief Compliance/HIPAA Officer in conducting investigations and special reviews, including those initiated by regulatory inquiries or internal concerns. Ongoing monitoring of regulatory developments and best practices is essential to ensure the audit program remains current and effective. Through this work, the Integrity Manager upholds revenue integrity and promotes a culture of compliance and ethical conduct throughout the organization. Performs duties and assignments promptly and efficiently.  Strives to protect the department’s reputation for creditability and objectivity. Maintains good public/working relations with other University Health executives, members of the Board of Managers, co-workers, employees, doctors, patients and guests.  Handles all personal contacts with professionalism, efficiency and integrity while preserving the confidential nature of information. 

EDUCATION/EXPERIENCE

Bachelor’s or Associate’s degree from an accredited college or university strongly preferred. Certification from AAPC or AHIMA as a Certified Professional Coder (CPC) and Certified Professional Medical Record Auditor (CMPA), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), or a Registered Health Information Technician (RHIT) is strongly preferred.  Minimum three years’ experience in clinical auditing and claims validation reviews within a hospital or Ambulatory Surgery Center (ASC) setting. The ideal candidate will possess expert-level knowledge of medical coding classifications, including ICD, CPT, and HCPCS, ensuring accuracy and compliance in coding practices. A strong understanding of reimbursement methodologies, including DRG, APC, and ASC payment structures, is preferred.

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