Healthcare Coding Compliance Auditor RUHS

For questions regarding this position please contact the Recruiter listed in the Supplemental Information section.

Riverside University Health System (RUHS)is seeking two skilled Coding Compliance Auditors (Administrative Services Manager I) to support the Health Systems Compliance Department.

Key responsibilities of this role include conducting thorough reviews of medical records to ensure compliance with coding regulations while providing feedback and education to coders and physicians to enhance coding accuracy and documentation quality. The position involves performing annual periodic and focused audits of physician inpatient and outpatient coding as requested. It also requires effective communication with all RAC stakeholders to ensure timely and accurate responses to inquiries. Additionally the role supports ongoing program development through training initiatives and process improvements delivers coding presentations to diverse audiences including physicians and other staff.

The ideal candidate will have at least five years of progressive experience in an acute care hospital setting including inpatient MS-DRG reimbursement along with 35 years of coding audit or compliance auditing experience. This includes extensive expertise in inpatient and outpatient auditing (MS-DRGs CC/MCC validation POA indicators PSI/HAC implications) managing external audits (RAC MAC OIG UPIC commercial payers) and strong knowledge of CMS IPPS/OPPS regulations OIG Work Plan priorities Medicare Conditions of Participation Official Coding Guidelines NCCI edits and medical necessity rules. The candidate should have experience conducting risk assessments developing audit work plans quantifying financial impact presenting findings to leadership collaborating across CDI HIM Revenue Integrity and Compliance teams providing provider education and supporting denials and appeals. Experience in large or multi-facility health systems proficiency with encoder and audit software (e.g. 3M Optum EPIC) is strongly preferred.

Two years of supervisory experience is required as well as one of the following certifications: CCS CPC RHIT/RHIA CDIP or CPMA.

• Schedule: 9/80 work schedule - hybrid

• Location: 7898 Mission Grove Parkway Riverside

This class has been deemed eligible for the Performance Recognition Plan as set forth under Article 3 Section 311 of the County Management Resolution. Program eligibility requires employees to be in a leadership position manage other employees or programs and have significant influence on the achievement of organizational objectives.

Every day at Riverside University Health System Medical Center a dedicated team of healthcare professionals and support staff come together to improve lives across Riverside County. Our nationally recognized programs and specialized services thrive because of the diverse talents and commitment of our team members. No matter your background or skill set youll discover meaningful opportunities and a strong sense of purpose here.

To learn more about RUHS Medical Center please visit

Conduct comprehensive audits of inpatient and outpatient medical records to ensure accurate ICD-10-CM/PCS CPT and HCPCS coding in accordance with official coding guidelines and regulatory requirements.

Evaluate DRG assignment accuracy and validate principal and secondary diagnoses procedures CC/MCC capture and POA indicators.

Monitor compliance with federal and state regulations including Medicare Medicaid and commercial payer policies.

Assess adherence to documentation standards and identify risk areas related to medical necessity upcoding undercoding and unbundling.

Perform focused audits based on risk assessments OIG Work Plan priorities denials trends and internal compliance initiatives

Collaborate with Clinical Documentation Integrity (CDI) Health Information Management (HIM) Revenue Cycle and Case Management teams to resolve coding discrepancies and improve documentation quality.

Prepare detailed audit reports outlining findings root cause analysis financial impact and corrective action recommendations.

Educate providers coders and revenue cycle staff on regulatory updates coding changes audit findings and compliance risks.

Track audit metrics monitor corrective action plans and perform re-audits to ensure sustained compliance improvements.

Support internal investigations and respond to external audit requests (RAC MAC OIG commercial payers).

Maintain knowledge of CMS transmittals coding clinic updates and evolving regulatory guidance affecting acute care services.

Contribute to enterprise-wide compliance risk assessments and annual compliance work plan development.

Whats Next
This recruitment is open to all applicants.Applicants who are current County of Riverside employees and/or current employees of Riverside University Health System may be considered before other applicants depending on the volume of applications received.

For questions about this recruitment please contact:
Angela Levinson
Email:
Phone:

APPLICATION INFORMATION

Veterans Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify attach the required documents to your job application. Documents include a copy of your (or your spouses) Member-4 Form DD-214 indicating dates of service. For spousal preference and as applicable the following documents: a copy of your marriage certificate spouses death certificate a letter of spouses disability and/or letter of service-related death (if available) from the U.S. Veterans Administration. For privacy reasons it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans preference. For complete details and documentation requirements please review the Veterans Preference Policy C-3 here: Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation please visit the Disability Access Office web page located at: of Education
If using education to qualify or when requested by the recruiter upload a copy of any license(s) official/unofficial transcript(s) degrees and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators Inc. (AICE).

Work Authorization Requirement
Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs including H1-B visas and will not provide sponsorship for any employment-based visas.

Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race color religion sex national origin age disability sexual orientation gender gender identity gender expression marital status ancestry medical condition (cancer and genetic characteristics) genetic information or denial of medical and family care leave or any other non-job-related factors.

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period
As an Approved Local Merit System all County of Riverside employees except those serving At Will are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding County Resolution or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the Apply link located on this page to submit your application. For additional instructions on the application process examinations Veterans preference pre-employment accommodation or other employment questions please refer to our web site .

If you are experiencing technical problems you may contact the applicant support desk Monday through Friday 6 am to 5 pm Pacific Time at or toll-free 1-.