Coding Compliance Specialist, Auditor

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $55k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Sound Physicians

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2001

🏥 Healthcare

🤝 B2B

Healthcare • B2B

Sound Physicians is a physician-led healthcare services company that partners with hospitals and health systems to deliver specialty clinical programs including emergency medicine, hospital medicine, critical care (including tele-ICU), anesthesia, and accountable care for long-term and assisted living settings. The company combines clinical leadership, operational optimization, and revenue-cycle support to improve patient outcomes, stabilize hospital operations, and maximize financial performance through tailored, on-site and virtual care models.

📋 Description

• Review and respond to compliance hotline reports related to billing, coding, documentation, quality of care, and privacy concerns • Conduct investigations and document findings, including root cause analysis and resolution • Collaborate with Compliance, Revenue Cycle Management, Hospital Partners, and reporters • Escalate high-risk or regulatory issues as appropriate • Perform retrospective and focused medical-record audits evaluating coding accuracy, documentation completeness, and medical necessity • Conduct audits in response to identified risks, hotline complaints, and payer requests • Identify trends and potential areas of non-compliance • Prepare clear, concise audit reports with recommendations • Develop and support corrective action plans • Partner with operational and clinical leadership to ensure remediation • Provide education and guidance to providers and staff on coding, documentation, and compliance requirements • Conduct follow-up reviews to assess corrective-action effectiveness • Support privacy-related investigations, including potential HIPAA concerns • Document findings and mitigation activities while maintaining confidentiality • Coordinate and prepare documentation submissions for government inquiries, including Attorney General and CMS requests • Assist with analysis of payer findings and implementation of required actions • Analyze large data sets to identify trends, anomalies, and risk areas • Maintain audit and investigation tracking logs • Support compliance reporting and program metrics

🎯 Requirements

• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding guidelines • Understanding of federal and state regulations related to billing, coding, and privacy • Ability to conduct detailed audits and investigations • Strong analytical skills with the ability to process large data sets • Excellent written and verbal communication skills • High attention to detail and organizational skills • Ability to manage multiple priorities in a fast-paced environment • Proficiency in Microsoft Word and Microsoft Office Suite • Ability to work independently and collaboratively across departments • May require interaction with clinical staff, leadership, and external stakeholders • Maintains strict confidentiality in all aspects of work • Bachelor's degree in healthcare, business, or related field preferred, or equivalent experience • Minimum of 3–5 years of experience in coding, auditing, compliance, or related healthcare field • Active coding certification from AAPC (e.g., CPC or equivalent) required • Certification in Healthcare Compliance (CHC) or other HCCA-related certification preferred