Clinical Compliance Auditor

Position Highlights

• Job Type: Compliance and Revenue Cycle Auditor (RAC Auditor)
• Location: Community Hospital
• Schedule: Full-Time
• Final date to receive applications:January 31, 2026

• Bachelor’s Degree in health care or related field (Bachelor’s Degree in Nursing preferred)
• (1) year of related experience and/or training OR equivalent combination of education and experience.
• CHA, CCP, CCEP, CCS or CPC preferred. Understanding of the regulatory and accreditation environment related to hospitals and health care systems. Understanding reimbursement environment/requirements in acute and ambulatory care settings. Excellent computer skills, 10 key by touch, filing and typing proficiency. Familiarity with CPT-10 and ICD-10 coding.
• Internal Auditor manages compliance audit and monitoring activities pertaining to compliance and privacy.
• Collaborates with Chief Compliance and Privacy Officer on all internal and external audits and reviews, which are initiated by government agencies or government-contracted organizations, as well as commercial payer reviews.
• Performs monthly audits according to the established work plan and calendar and prepares work plan summary with appropriate action plans.
• Services as a member of the Corporate Compliance and Practice Compliance committees and presents summary of audit activities to the committees.
• Exercises due diligence in collaboration with Corporate Compliance and Privacy Officer to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when an offense is detected and prevent future similar offenses. Ensure the enforcement of compliance and privacy program standards.
• Provides results of audits and education to HIM, Revenue Cycle, physicians, hospital and clinic operations regarding charging, documentation, and billing requirements.
• Recovery Audit Contractor (RAC) Coordinator is responsible for the effective and strategic oversight of the CWHS Compliance response process for the Medicare RAC program and other RAC-like government healthcare review programs and activities. This includes the responsibility to research, develop, implement, coordinate and monitor effective practices for day-to-day operations associated with external review audits, and to liaison with all CWHS entities regarding parallel activities.
  
  Activities are largely, though not exclusively, focused on the review of clinical billing and related medical records to potentially recover over payments. In addition to oversight of the internal response process, the RAC Coordinator service as primary point of contact with external auditors, clarifies and resolves audits issues, collects data, and analysis trends to identify potential areas of increased risk.

• Internal Auditor manages compliance audit and monitoring activities pertaining to compliance and privacy.
• Collaborates with Chief Compliance and Privacy Officer on all internal and external audits and reviews, which are initiated by government agencies or government-contracted organizations, as well as commercial payer reviews.
• Performs monthly audits according to the established work plan and calendar and prepares work plan summary with appropriate action plans.
• Services as a member of the Corporate Compliance and Practice Compliance committees and presents summary of audit activities to the committees.
• Exercises due diligence in collaboration with Corporate Compliance and Privacy Officer to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when an offense is detected and prevent future similar offenses. Ensure the enforcement of compliance and privacy program standards.
• Provides results of audits and education to HIM, Revenue Cycle, physicians, hospital and clinic operations regarding charging, documentation, and billing requirements.
• Recovery Audit Contractor (RAC) Coordinator is responsible for the effective and strategic oversight of the CWHS Compliance response process for the Medicare RAC program and other RAC-like government healthcare review programs and activities. This includes the responsibility to research, develop, implement,…