Medical Coding Compliance Auditor

Description

At VMG Health, we’re more than just a team of experts; we’re trusted partners in the business of healthcare. Backed by a team of over 300 professionals and a history of more than 70,000 engagements since 1995, we bring experience, deep and wide, to every project. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. Our solutions-oriented approach to client needs is bolstered by our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients’ valuation, strategic, and compliance needs.

Position Summary

VMG Health is seeking an experienced Medical Coding Compliance Auditor to join its Coding Audit and Compliance (CAC) team. The Compliance Auditor will provide auditing, compliance, education, consulting, project management, and report writing services to a broad range of healthcare clients, including physician practices, hospitals, health systems, academic medical centers, law firms, private equity organizations, and other healthcare entities. This role is responsible for conducting documentation and coding reviews, regulatory research, due diligence support, provider education, compliance auditing, and developing corrective action recommendations. The Compliance Auditor will serve as a trusted resource to clients and internal team members, providing subject matter expertise in coding, documentation, compliance, and regulatory requirements. Strong analytical, critical-thinking, communication, and client-service skills are essential to success in this role. This is an excellent opportunity for a professional seeking to build a career in healthcare compliance and auditing with the support of an industry-recognized team.

Requirements

Key Tasks & Responsibilities

• Work as part of an audit team professionally and successfully complete client projects, meeting productivity and quality standards within established deadlines.
• Access necessary medical record documentation from client EMR systems.
• Complete detailed analysis of medical records for chart content, coding accuracy, and documentation requirements.
• Utilize audit reporting tools to document audit results and prepare reports for quality assurance review and client delivery.
• Interpret and apply CMS, AMA, OIG, NCCI, third-party payer, and other regulatory guidance to audit findings and compliance recommendations.
• Identify documentation, coding, billing, reimbursement, and compliance risk trends and communicate findings to clients and internal leadership.
• Develop reports of audit findings, compliance recommendations, and corrective action plans based on identified issues.
• Prepare and present audit results, executive summaries, and compliance recommendations to providers, administrators, attorneys, and executive leadership.
• Conduct education and training sessions for internal team members, providers, and clients.
• Educate and serve as a resource for providers regarding documentation, coding, and compliance matters.
• Participate in quality assurance and peer review activities to ensure consistency, accuracy, and defensibility of audit outcomes.
• Assist with the development and maintenance of audit tools, educational materials, methodologies, and compliance resources.
• Coordinate, research, and access resources necessary for the execution of client engagements and special projects.
• Assist leadership in ensuring projects are delivered on time, within scope, and within budget.
• Support the development and clarification of project scope and objectives while engaging relevant stakeholders and confirming project feasibility.
• Develop and maintain strong relationships with clients and key stakeholders.
• Review quality assurance audit reports and implement necessary corrections and adjustments.
• Maintain current knowledge of healthcare auditing principles, government regulatory compliance guidance, reimbursement methodologies, and third-party payer requirements.
• Utilize Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) and other audit-related technologies to complete assigned tasks

Qualifications

Education

• High School Diploma required.
• Bachelor's degree preferred.

Experience

• Minimum of 3 years of healthcare auditing, documentation review, compliance, regulatory, or related healthcare experience.
• Experience conducting detailed medical record reviews and evaluating documentation requirements.
• Experience auditing professional coding across multiple specialties and service settings.
• Demonstrated experience with healthcare regulatory guidelines, including teaching physician settings, incident-to billing, split/shared services, and payer requirements.
• Experience analyzing payer policies, regulatory guidance, and reimbursement requirements and translating findings into actionable recommendations.
• Experience developing audit findings, corrective action plans, and compliance recommendations.
• Experience preparing written audit reports and presenting findings to providers, executives, compliance leadership, and other stakeholders.
• Experience delivering provider and staff education related to documentation, coding, and compliance requirements.
• Experience working independently in a consulting or client-service environment preferred.

Knowledge & Skills

• Advanced knowledge of physician documentation, E/M coding, compliance auditing methodologies, healthcare reimbursement principles, and regulatory requirements.
• Ability to evaluate complex documentation scenarios and apply nuanced regulatory guidance to support defensible audit conclusions.
• Strong written communication skills, including audit report writing, corrective action planning, and executive-level communications.
• Ability to communicate complex compliance and regulatory information clearly and confidently in both individual and group settings.
• Ability to effectively facilitate provider education and training.
• Ability to identify trends, interpret data, and develop practical, risk-based recommendations.
• Strong organizational, planning, project management, problem-solving, and decision-making skills.
• Ability to manage multiple priorities and projects in fast-paced environments while consistently meeting deadlines.
• Strong attention to detail in auditing, compliance reviews, and documentation analysis.
• Commitment to exceptional client service and relationship management.
• Demonstrated professionalism and executive presence when interacting with clients and stakeholders.
• Ability to foster teamwork and collaboration while maintaining a professional and positive attitude.
• Familiarity with AI-powered auditing and compliance tools to enhance accuracy, efficiency, and reporting.
• Advanced proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint) and related technologies.
• Consistently achieves high productivity and quality outcomes while working independently with minimal supervision.

Certifications

Required

• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder (CPC)

Preferred

• Certified in Healthcare Compliance (CHC)
• Certified Professional Compliance Officer (CPCO)
• Certified Risk Adjustment Coder (CRC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Certified Outpatient Coder (COC)
• Other healthcare auditing or compliance-related certifications