Compliance Audit Manager Corporate Compliance
Listed on 2026-10-19
-
Healthcare
Medical Billing and Coding, Healthcare Compliance, Medical Records, Healthcare Administration
Compliance Audit Manager - FT
- Days
- Corporate Compliance - 22258
US:
TX:
Edinburg | LEGAL, COMPLIANCE, & RISK | Full Time
Posted 2 days ago
DescriptionDHR Health - US:
TX:
Edinburg
- Days
Summary:
MISSION STATEMENT:
Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.
VISION:
Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.
POSITION SUMMARY:
The Compliance Audit Manager is responsible for ensuring the accuracy and completeness of clinical coding that results in appropriate reimbursement and date integrity and validation of the coded information for external and internal affairs.
POSITION EDUCATION/
QUALIFICATIONS:
High School diploma or GED required
CCS, CCA, COC or CPC certification required
Three (3) years of hospital coding experience
Good written and verbal communication skills are required.
Ability to read, write and speak English
Ability to communicate clearly and concisely with all levels of management.
JOB KNOWLEDGE/
EXPERIENCE:
Outpatient Auditing experience required
Auditing for all outpatient service lines, including Emergency, Day Surgery, Endoscopy, Observation or Single Visits preferred
Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines
Extensive knowledge of reimbursement systems and regulations and policies pertaining to documentation, coding, and billing
Knowledge of database applications and spreadsheet design
Demonstrates commitment to Doctors Hospital at Renaissance Health Systems process by integrating our culture in all internal and external customer interactions
Responsibilities:
POSITION RESPONSIBILITIES:
Develop, conduct, and oversee retrospective revenue cycle audits, prospective (pre-bill) audits, and coding validation activities, including Cerner Charge Assist reviews, for high-risk and below-benchmark Evaluation and Management (E/M) services. Communicates audit findings, educational recommendations, and corrective feedback to providers and leadership to promote coding accuracy, documentation integrity, and regulatory compliance.
Monitor and tracks Recovery Audit Contractor (RAC) audit findings, results, and corrective action plans; maintains documentation and reports outcomes to support compliance initiatives.
Manage outsourced audit activities by providing quality oversight, educational feedback, and corrective guidance to external auditors.
Monitor CMS Targeted Probe and Educate (TPE) topics and conduct focused outpatient and inpatient E/M audits to ensure compliance with regulatory requirements.
Perform data analysis of coding accuracy, billing performance, reimbursement outcomes, denial trends, and provider documentation patterns to identify risks and opportunities for improvement.
Design, develop, and maintain audit tools, reports, and monitoring processes to evaluate the accuracy of clinical coding and documentation practices.
Monitor Tableau dashboards and distribute provider census metrics, physician documentation delinquency reports, and other operational performance data.
Communicate audit findings, compliance recommendations, coding guidance, and documentation best practices to physicians, providers, leadership, and staff.
Conduct new physician orientation and onboarding education on coding, documentation, billing compliance, reimbursement methodologies, organizational policies, HIPAA privacy and security standards, and regulatory requirements to support accurate documentation, compliant billing practices, and protection of patient health information.
Develop and deliver coding, documentation, billing, and compliance education for resident physicians and Graduate Medical Education (GME) programs.
Serve as a subject matter expert and resource for providers and staff regarding coding standards, documentation requirements, reimbursement methodologies, and regulatory guidelines.
Collaborate with leadership and management to address clinical documentation, coding, compliance, reimbursement, and revenue integrity issues.
Maintain current knowledge of coding guidelines, CMS regulations, payer requirements, reimbursement methodologies, and industry best practices.
Adhere to AHIMA Standards of Ethical Coding, official coding guidelines, regulatory requirements, and organizational policies.
Support professional development initiatives through…
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