Highlights
Experience performing medical record and billing audits/reviews, including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM, and revenue), and reviews for charge and reimbursement accuracy required. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation audits to ensure accurate code assignment, appropriate billing, integrity of the medical record, and compliance with federal and state healthcare program requirements.
Numbers & Facts
| Location | Fresno, CA |
Description
Overview
Opportunities for you!
- Consecutively recognized as a top employer by Forbes, and in 2025 by Newsweek
- Free Continuing Education and certification
- Tuition reimbursement, education programs and scholarships
- Vacation time starts building on Day 1, and builds with your seniority
- Free money toward retirement with a 403(b) and matching contributions
- Great food options with on-demand ordering
- Free parking and electric charging
Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.
We know that our ability to provide the highest level of care is through taking care of our incredible teams. Learn more on our Benefits page.
Responsibilities
The Coding Compliance Auditor is a member of the Compliance Office and contributes to the Community Health System's mission to better the lives of all those we serve. As a Coding Compliance Auditor, you will be responsible for conducting coding and documentation audits to ensure accurate code assignment, appropriate billing, integrity of the medical record, and compliance with federal and state healthcare program requirements.
The role requires a highly confident coder who can audit both facility coding and professional fees for partners, as well as audit other coders and physicians.
Qualifications
Education
- Associate''s Degree in Business, Information Systems, Nursing, Health Care, or a related field required
- Bachelor''s Degree in Business, Information Systems, Nursing, Health Care, or a related field preferred
Experience
- Experience performing medical record and billing audits/reviews, including clinical documentation, medical terminology, codes (CPT, HCPCS, ICD-10-CM, and revenue), and reviews for charge and reimbursement accuracy required
- Knowledge of federal, state, and private payer guidelines required
One of the following is required:
- 5 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS, if qualifying with an Associate's Degree
- 3 years of healthcare coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCS, if qualifying with a Bachelor's Degree
- Epic experience preferred
- Experience with 3M or Optum is preferred
- Experience completing a formal validation report after completing audits preferred.
Licenses and Certifications:
One of the following is required:
CCS - Certified Coding Specialist
CCS-P - Certified Coding Specialist- Physician-based
CMAS - Certified Medical Audit Specialist
CPMA - Certified Professional Medical Auditor
CPC - Certified Professional Coder
Additional certifications preferred:
RHIA - Registered Health Information Administrator
RHIT - Registered Health Information Technician
Two or more certifications preferred
Disclaimers
- Pay ranges listed are an estimate and subject to change.• If any bonuses are noted, they are only applicable to external hires meeting criteria.