[Hiring] Compliance Auditor @Cardinal Health

Role Description

The Compliance Auditor is responsible for conducting coding, documentation audits to ensure adherence to regulatory requirements, payer policies, and organizational standards. This position focuses primarily on Medical Oncology, Radiation Oncology and Urology services and requires advanced knowledge of CPT, HCPCS, ICD-10-CM, reimbursement methodologies, and healthcare compliance regulations.

• Conduct coding, billing, and documentation audits to identify compliance, coding, and reimbursement risks.
• Review medical records and claims to ensure compliance with regulatory, payer, and organizational requirements.
• Analyze audit findings, identify trends and opportunities for improvement, and recommend corrective actions.
• Prepare audit reports and communicate findings to leadership, providers, coders, and operational stakeholders.
• Provide education and guidance to physicians, coders, and staff on coding, documentation, compliance requirements, and industry best practices.
• Research coding and documentation questions to support accurate code assignment and reimbursement.
• Assign and validate ICD-10-CM, CPT, HCPCS, and modifier usage for professional and facility services as applicable.
• Coordinate responses to external audit and medical record requests and ensure timely submission of required documentation.
• Maintain current knowledge of coding guidelines, payer policies, and healthcare regulations impacting Medical Oncology, Radiation Oncology, and Urology services.
• Collaborate with Compliance, Revenue Cycle, Coding, Clinical, and Operational teams on monitoring activities and compliance initiatives.
• Perform other duties as assigned.

Qualifications

• Coding certification from an accredited source (AAPC, AHIMA, etc.)
• 4-8 years of experience, preferred
• Undergraduate degree, preferred

Requirements

• Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects.
• May contribute to the development of policies and procedures.
• Works on complex projects of large scope.
• Develops technical solutions to a wide range of difficult problems.
• Solutions are innovative and consistent with organization objectives.
• Completes work; independently receives general guidance on new projects.
• Work reviewed for purpose of meeting objectives.
• May act as a mentor to less experienced colleagues.

Benefits

• Medical, dental and vision coverage
• Paid time off plan
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs