Cape Cod Healthcare · 4 hours ago
Internal Auditor, Corporate Compliance Billing & Coding
Hyannis, MA
Full-time
Onsite
Senior Level
$87K/yr - $125K/yr
5+ years expCape Cod Healthcare is dedicated to providing high-quality healthcare services. The Coding and Billing Compliance Auditor ensures the accuracy and regulatory compliance of clinical documentation, coding, and billing practices while conducting audits and providing education to staff to mitigate risk and optimize reimbursement.
Health Care
Responsibilities
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers
Challenges current working practices identifies process improvement opportunities and presents recommendations and solutions to management
Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence
Conduct regular audits of medical records, coding, and billing practices to ensure accuracy and compliance with federal, state, and payer regulations
Evaluate claims for compliance with ICD-10, CPT, HCPCS, and other applicable coding standards, identifying coding errors, documentation deficiencies, and billing discrepancies
Perform both scheduled and impromptu audits of physician and coder documentation to verify accuracy, compliance, and appropriate code assignment
Monitor adherence to internal policies, procedures, and the organization’s Code of Conduct, tracking regulatory changes to maintain ongoing compliance
Assist with risk assessments and internal investigations related to billing, coding, and documentation practices
Prepare comprehensive audit reports summarizing findings, trends, and recommendations, maintaining detailed documentation of audits, corrective actions, and follow-up activities
Present findings to leadership, compliance committees, and other key stakeholders, ensuring transparency and accountability
Provide timely feedback and education to coders, billers, and clinical staff on documentation and coding requirements
Develop, implement, and evaluate training programs addressing coding standards, compliance updates, and audit outcomes
Serve as a knowledgeable resource for coding and reimbursement inquiries, offering guidance and recommendations as needed
Collaborate with Revenue Cycle, Health Information Management (HIM), Clinical Documentation Improvement (CDI), and Compliance teams to promote accuracy and consistency across functions
Support external audits and respond to payer or government inquiries in coordination with legal and regulatory teams
Utilize audit software and data analytics tools to identify patterns of risk, noncompliance, or revenue loss, and recommend process improvements to enhance accuracy and reduce denials
Provide coding support and perform related duties as required
Assist with other departmental or organizational initiatives as reasonably assigned
Qualification
Required
Ability to read, write and communicate in English
Bachelor's degree (or higher) preferably in Law, Healthcare, Compliance, Finance, Business, or Accounting
Minimum of five years' experience in physician coding, including auditing experience
Current certification: CPC (Certified Professional Coder) through AAPC or CCS-P (Certified Coding Specialist – Physician-based) through AHIMA
Comprehensive knowledge of coding standards including ICD-9 and ICD-10, CPT, and physician billing requirements, as well as physician reimbursement methodologies
Strong verbal and written communication skills, with the ability to effectively interact with a wide range of individuals across clinical and administrative settings
Proficiency with software applications related to electronic health records (EHR) and billing systems to ensure accurate documentation and reporting
Proven ability to develop and deliver training materials that enhance understanding and compliance in coding, billing, and documentation practices
Skilled in building and maintaining positive working relationships with physicians and interdisciplinary teams to promote collaboration and adherence to compliance standards
Performs other related duties as assigned or requested to support departmental and organizational goals
Preferred
Specialty in E&M CEMC (Certified Evaluation and Management Coder) through AAPC, or CPMA (Certified Professional Medical Auditor) through AAPC
Company
Cape Cod Healthcare
Cape Cod Healthcare offers a comprehensive array of medical services delivered by top-notch teams of healthcare providers.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Michael Lauf
President and CEO
Richard Silveria
Chief Financial Officer
Recent News
2025-09-10
Company data provided by crunchbase