Compliance Auditor Senior - Healthcare Legal and Regulatory; Eastern resident

Compliance Auditor Senior - Healthcare Legal and Regulatory (Eastern United States resident) Job Summary

The Senior Compliance Auditor ensures the integrity and accuracy of facility and professional compliance audits, monitoring, and provides compliance education for facility and professional documentation, coding, and billing. They serve as a mentor for Compliance Auditors and assist management with onboarding new auditors. The position requires judgment and critical thinking to determine appropriate corrective actions for non‑compliance and ensure those actions are fully implemented.

• Performs scheduled facility and/or professional audits on the adequacy of medical record documentation to support coding (DRG, CPT, ICD‑10) and billing as required by the compliance work plan.
• Performs audits resulting from unplanned investigations.
• Reviews peers’ work products and serves as a mentor for compliance staff.
• Serves as primary lead for facility/professional billing compliance education, including auditing, trending, and providing audit feedback to coding staff and providers.
• Coordinates the development and implementation of corrective action and improvement plans, performing root cause analysis.
• Prepares responses to governmental audits, evaluates findings, and manages the appeals process.
• Assesses compliance risk areas across Geisinger entities and assists with creating the Compliance Department’s work plan.
• Performs research to ensure compliance with coding and diagnostic guidelines.
• Provides compliance guidance to staff and serves as a resource for leadership, management, and medical staff on federal payor billing compliance.

Associate's Degree in a related field (Required).

Minimum of 7 years related work experience (Required).

One of the following coding or auditing certifications required: CCS, CPC, RHIA, RHIT, or CPMA.

• Seniority Level: Mid‑Senior level
• Employment Type:
  
  Full‑time
• Job Function:
  Finance and Sales
• Industry: Hospitals and Health Care

Everything we do is about caring for our patients, members, students, and community. We value kindness, excellence, learning, innovation, safety, and collaboration. We believe a diverse workforce strengthens our team.

We are a proud affirmative action, equal opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.