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Jobs › Hyannis, MA › Internal Auditor Cape Cod Healthcare, Inc. Internal Auditor Hyannis, MA Apply The Coding and Billing Compliance Auditor ensures the accuracy, integrity, and regulatory compliance of clinical documentation, coding, and billing practices across the health system. The position conducts audits, identifies risks and discrepancies, provides education, and recommends process improvements to reduce compliance risk, prevent fraud, and support accurate reimbursement.

KEY RESPONSIBILITIES

• Conduct scheduled and unannounced audits of medical records, physician documentation, coding, and billing to ensure compliance with federal, state, payer, and organizational requirements.
• Review claims for compliance with ICD-10, CPT, HCPCS, physician billing requirements, and reimbursement guidelines.
• Identify coding errors, documentation deficiencies, billing discrepancies, compliance risks, and opportunities for process improvement.
• Monitor compliance with organizational policies, procedures, Code of Conduct, and changing regulatory requirements.
• Assist with risk assessments and internal investigations involving billing, coding, and documentation.
• Prepare audit reports documenting findings, trends, corrective actions, recommendations, and follow-up activities.
• Present audit findings and recommendations to leadership, compliance committees, and other stakeholders.
• Provide education and timely feedback to physicians, coders, billers, and clinical staff regarding documentation, coding, billing, and compliance requirements.
• Develop and deliver training related to coding standards, regulatory updates, and audit findings.
• Serve as a resource for coding, billing, reimbursement, and compliance questions.
• Collaborate with Revenue Cycle, Health Information Management (HIM), Clinical Documentation Improvement (CDI), and Compliance teams to promote accuracy and consistency.
• Support external audits and respond to payer and government inquiries in coordination with appropriate departments.
• Use audit software, EHR/billing systems, and data analytics to identify trends, risk, noncompliance, revenue loss, and denial opportunities.
• Recommend improvements that increase accuracy, compliance, efficiency, and reimbursement.
• Support organizational continuous-improvement initiatives and perform related duties as assigned.

QUALIFICATIONS

• Bachelor?s degree or higher in Healthcare, Compliance, Finance, Business, Accounting, Law, or related field; equivalent education and experience may be considered.
• Minimum 5 years of physician coding experience, including auditing experience.
• Current CPC (AAPC) or CCS-P (AHIMA) certification required.

• Preferred:

  CEMC (Certified Evaluation & Management Coder) or CPMA (Certified Professional Medical Auditor).
• Comprehensive knowledge of ICD-9/ICD-10, CPT, HCPCS, physician billing, and reimbursement methodologies.
• Strong written and verbal communication skills with the ability to work effectively with clinical and administrative staff.
• Proficiency with EHR, billing, audit, and related software systems.
• Ability to develop and deliver effective training and educational materials.
• Strong analytical, problem-solving, organizational, and process-improvement skills.
• Demonstrated ability to build positive working relationships with physicians and interdisciplinary teams.
• Ability to read, write, and communicate effectively in English.

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