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Compliance Auditor
Job Location:
Job Location:
Chesapeake, VA - USA
Monthly Salary:
Not provided by the employer
Monthly Salary:
Posted:
27 August 2026 (26 days ago)
Posted:
Application Deadline:
24 November 2026
Application Deadline:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
Position Summary
The Compliance Auditor plans schedules and performs comprehensive internal professional fee audits to include routine audits focused audits for cause audits and not for cause audits for Chesapeake Regional Healthcare (CRH) and all of its affiliated entities. Performs detection of documentation coding and billing errors as well as collaboration with appropriate stakeholders to ensure corrective action and/or appropriate response to identified issues. Communicates audit results to providers coders management and other appropriate staff. Develops and delivers provider and coder education. Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to regulatory compliance with guidelines related to professional fee documentation coding and billing. Stays abreast of documentation coding and billing regulations and standards and serves as a subject matter expert on the interpretation and application of documentation along with coding rules and regulations.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned. Essential functions may include but are not limited to the functions listed below:
- Plans schedules and performs comprehensive internal professional and hospital fee audits as determined by the Compliance Work Plan to include routine and focused audits.
- Detection of documentation coding and billing errors as well as collaboration with appropriate stakeholders to ensure corrective action and/or appropriate responses are implemented to address identified issues.
- Communicates audit results to providers coders management and other appropriate staff and makes recommendations to ensure sustained compliance and improvement.
- Develops and delivers provider and coder education as needed.
- Evaluates the effectiveness of internal controls designed to ensure that processes and practices lead to regulatory compliance with guidelines related to professional and hospital fee documentation coding and billing including federal and state regulations CMS and OIG compliance standards.
- Stays abreast of ever-changing documentation coding and billing regulations and standards.
- Serves as subject matter expert on interpretation and application of documentation and coding rules and regulations.
- Develops compliance auditing plans based on thorough research on studies conducted by government agencies and professional organizations.
- Compiles reports on the results of external and internal audits and presents these reports to the relevant supervisors and department heads.
- Performs audits according to the established Compliance Work Plan and calendar and prepares Compliance Work Plan summary slides with appropriate corrective action plans.
- Assists with the modification of the Compliance Work Plan calendar through the year to include additional audits based on audit results risks and corrective action plans.
- Assists the Compliance Committee and presents summary of audit activities to the committee.
- Provides results of audits and education to HIM Revenue Cycle Departments physicians hospital and clinic operations regarding charging documentation and billing requirements.
- Assists departments with development of corrective action plans (CAPs) as needed and ensures CAPs are implemented and evaluated for effectiveness by performing follow up audits/reviews in a timely manner.
- Communicates effectively with the Corporate Compliance team and CRH aand all of its affiliated entities departments following the CRH Code of Conduct.
- Performs medical record audits of documentation coding and billing for technical and professional services including: CPT; ICD10; HCPCII; DRG; APC; APG; Modifiers; Non-Physician Practitioner Documentation (including incident-to guidelines) and other services;
- Conducts audits of electronic and manual documentation coding and billing systems.
- Develops formal audit reports of findings and recommendations which are presented to senior management of applicable department the Corporate Compliance Committee and Operations Quality and Safety Committee.
- Participates in external government audits including but not limited to: Centers for Medicare and Medicaid Services (CMS); Office of Inspector General (OIG); Medicaid Fraud Control Unit (MFCU); Virginia Department of Health (DOH); Medicaid Integrity Program Contractor (MIC); Recovery Audit Contractor (RAC); Zone Program Integrity Contractor (ZPIC); Health Care Fraud Prevention and Enforcement Action Team (HEAT)
- Participates in development of voluntary disclosures and repayments to federal and state agencies.
- Conducts opening and closing meetings with senior management of applicable department being audited.
- Identifies compliance risk areas and develops action plans accordingly.
- Develops and coordinates analysis of encounter forms and documentation templates.
- Audits and enforces compliance policies and procedures.
- Develops and conducts documentation coding and billing curriculum and education classes for more than 100 physicians allied health professionals and coding and billing associates annually.
- Assists in development of risk areas and audit creation.
- Assists with distribution of all Medicare and Virginia Department of Health updates and code changes to the appropriate associates.
- Facilitates responses to compliance-related inquiries (phone e-mail in-person).
- Responsible for other matters as assigned by the Chief Corporate Compliance Officer and/or Corporate Compliance Manager and Auditor.
Ideal Candidate Attributes
The ideal candidate will:
- Pay close attention to detail and strive for excellence.
- Possess curiosity for learning CRHs business products and solutions.
- Thrive in a dynamic environment by practicing effective time management and prioritization of tasks.
- Comfortable in making recommendations in compliance audit and contractual matters.
- Effectively assist cross-functional projects to completion.
- Display strong communication and writing skills.
- Display excellent judgment and strong organizational skills
- Possess a willingness and ability to work and coordinate activities across a large number of individuals in various departments.
- Ability to pass required background checks and clearances.
Additional Responsibilities
- Conduct special projects as assigned.
- Perform other job-related duties as necessary or assigned.
Minimum Qualifications and Requirements
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to pass required background checks and clearances.
- Experience as a coder in a hospital and/or healthcare environment
- Extensive knowledge of evaluation and management coding modifiers provider-based billing and auditing principles
- American Academy of Professional Coders (AAPC) coding certification (such as Certified Professional Coder (CPC) or dual CPC and Certified Professional Biller (CPB)) or to obtain within one (1) year of hire
- An in-depth understanding of the industrys rules guidelines and regulations
- Strong attention to detail analytical and statistical skills
- Strong communication and multitasking skills
- Dedication to objectivity
- Experience in healthcare revenue cycle auditing clinical operations and/or compliance preferred
- Knowledge of DRG CPT CDM and billing operations
- Knowledge of hospital department operations
- Knowledge of and experience with EPIC and Athena electronic medical records
- Strong Skills with Microsoft products (Excel Word and Power Point)
- Strong verbal and written communication skills
Preferred Qualifications
- Three (3) years auditing experience in a hospital and/or healthcare environment
- Auditing certification such as Certified Professional Medical Auditor (CPMA) or other accredited auditing certification
- Bachelors degree in Nursing Healthcare Administration Business and/or Accounting
- Health Care Compliance Association (HCCA) membership and certification
Required Experience:
IC
About Company
Chesapeake Regional Healthcare is a health system laser-focused on innovation, known for making medical history in the region and providing patients with truly personal care. Its hospital, Chesapeake Regional Medical Center, is the only independent, community-based acute care hospital ... View more
