Hospital Compliance Auditor

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life‑threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago, and Phoenix.

Our dedicated and compassionate employees are driven by a common mission: to deliver the cures of tomorrow to the people who need them today.

The Hospital Compliance Auditor conducts audits systemwide to determine organizational integrity within the Hospital Compliance Program and reviews hospital and provider‑based site practices to ensure they adhere to all relevant healthcare regulations and laws. Audits evaluate systems, charge capture, and hospital billing, including detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed.

The Hospital Compliance Auditor evaluates the adequacy and effectiveness of controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and federal and state regulations and guidelines, CMS and other third‑party payer billing rules, and OIG compliance standards.

The Auditor serves as an institutional subject‑matter expert and authoritative resource on auditing and monitoring practices and the interpretation and application of documentation and coding rules and regulations, including medical necessity of services delivered.

This position sits within the Healthcare Regulatory and Reimbursement Compliance vertical of the Ethics & Compliance program, is a member of the Hospital Compliance team, and reports to the System Manager, Hospital Compliance.

• Implement and manage a comprehensive systemwide proactive annual audit plan for the Hospital Compliance Program with a focus on high‑risk areas.
• Plan and perform hospital compliance‑related systems, revenue cycle, charge capture, and claims audits, including the accuracy and adequacy of documentation and coding related to hospital billing and medical necessity reviews.
• Initiate and manage auditing and monitoring as needed in conjunction with investigations and inquiries and assist with corrective action plans.
• Conduct analysis to identify inappropriate hospital billing and coding practices, identify and report compliance issues and concerns in addition to the claims and financial impact, and make recommendations for corrective action.
• Distill and summarize complex audit findings into digestible education and action items for stakeholders, prepare written reports of audit findings and recommendations, present to appropriate stakeholders, evaluate the adequacy of management corrective action to improve deficiencies, and maintain audit records.
• Assist in validating the accuracy of external audits, utilization management reporting, and other inquiries.
• Assist departmental management with the development of tools, templates, and process improvement recommendations.
• Assist in documentation and internal evaluation of the Ethics & Compliance Program effectiveness consistent with professional standards.
• Understand where regulatory guidance and hospital policies and procedures intersect in terms of compliant billing and coding, and provide customer feedback to guide decision making.
• In conjunction with the department manager, provide education and feedback to stakeholders when audit deficiencies are identified.
• Stay current with Medicare, Medicaid, and other third‑party rules and regulations, CPT, ICD‑10 coding updates, and enhance professional growth and development by participating in educational programs related to such topics. Serve as a system resource to answer billing appropriateness questions and those arising from audits, including government audits.
• Maintain knowledge of City of Hope provider billing and collection systems, including report‑writing capability, and work with Information Systems personnel to identify and request data needed for audits.

• Bachelor’s degree; 3 additional years of experience may substitute for a minimum education requirement.
• Seven (7) years of auditing and coding experience.
• Certified Coding Specialist (CCS) and/or AHIMA, AAPC, or other equivalent recognized coding certification (required).

City of Hope employee pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

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