Must have experience working collaboratively with diverse groups in a healthcare environment.
Must be familiar with government healthcare reimbursement systems.
Must be detail-oriented and highly organized, with the ability to manage multiple priorities effectively.
Must be able to work both independently and collaboratively to improve processes and outcomes.
Must be able to interpret data and identify patterns that support compliance and operational improvement.
Must communicate clearly and professionally with clinical and administrative teams.
Responsibilities
Audit service documentation for completeness, accuracy, and compliance with payer requirements.
Use audit tool software to conduct audits, document findings, and support audit activities.
Collaborate with internal audit staff on joint projects and identify and communicate opportunities to improve audit processes.
Educate providers on audit findings and communicate results clearly, concisely, and accurately.
Analyze anomalies identified through audit processes and escalate findings for further review as appropriate.
Apply program-specific regulatory requirements and dual-program audit procedures when conducting audits.
Perform audit activities in accordance with established efficiency standards and expectations set by Audit Services leadership.
Meet regularly with Compliance and Audit leadership to discuss audit findings, processes, priorities, and opportunities for improvement.
Evaluate the impact of clinical and operational changes on audit processes and implement or recommend actions to mitigate identified risks.
Participate in the review and resolution of claim rejections and reimbursement discrepancies in collaboration with Patient Accounting to support accurate reimbursement and regulatory compliance.
Monitor documentation trends, identify potential deficiencies and compliance concerns, and report findings to appropriate personnel.
Conduct follow-up clinical documentation improvement education based on audit findings and results.
Review medical codes using ICD-10 and CPT coding systems to assess coding accuracy and compliance with applicable requirements.
Extract and analyze reports from applicable electronic health record systems to support auditing, monitoring, and reporting activities.
Perform other duties as assigned.
Desired Qualifications
At least one year of medical terminology experience is preferred.
Experience with ICD, DSM-V, and Excel is preferred.
Help strengthen documentation quality and support compliant, high-impact care across the communities we serve.
*Remote position open to Missouri residents only.
The Compliance Auditor plays an important role in supporting clinical documentation accuracy, regulatory compliance, and continuous quality improvement across the organization. This position partners with clinical, finance, and operational teams to audit documentation, identify trends, provide education, and help ensure services are documented in a way that supports quality care, compliance standards, and accurate reimbursement.
This is a great opportunity for someone who enjoys problem-solving, analyzing data and trends, collaborating across departments, and helping improve systems and processes that support patient care and organizational excellence.
· Audits service documentation for completeness, accuracy and compliance with payer requirements
Utilizes audit tool software to conduct audits, document findings and support audit activities
Collaborates with internal audit staff on joint projects and identifies and communicates opportunities to improve audit processes
Educates providers on audit findings and communicates results clearly, concisely and accurately
Analyzes anomalies identified through audit processes and escalates findings for further review as appropriate
Applies program-specific regulatory requirements and dual-program audit procedures when conducting audits
Performs audit activities in accordance with established efficiency standards and expectations set by Audit Services leadership
Meets regularly with Compliance and Audit leadership to discuss audit findings, processes, priorities and opportunities for improvement
Evaluates the impact of clinical and operational changes on audit processes and implements or recommends actions to mitigate identified risks
Participates in the review and resolution of claim rejections and reimbursement discrepancies in collaboration with Patient Accounting to support accurate reimbursement and regulatory compliance
Monitors documentation trends, identifies potential deficiencies and compliance concerns, and reports findings to appropriate personnel
Conducts follow-up clinical documentation improvement education based on audit findings and results
Reviews medical codes using ICD-10 and CPT coding systems to assess coding accuracy and compliance with applicable requirements
Extracts and analyzes reports from applicable electronic health record (EHR) systems to support auditing, monitoring and reporting activities
Performs other duties as assigned
High School/GED required
At least one (1) year of medical terminology preferred
Must have experience working collaboratively with diverse groups in a healthcare environment
Must be familiar with government healthcare reimbursement systems
Experience in ICD, DSM V, and Excel preferred
You’ll be a great fit for this role if you:
Are detail-oriented and highly organized, with the ability to manage multiple priorities effectively
Enjoy working both independently and collaboratively to improve processes and outcomes
Can interpret data and identify patterns that support compliance and operational improvement
Communicate clearly and professionally with clinical and administrative teams
Value accuracy, accountability, and continuous learning in a healthcare environment
Are passionate about supporting quality care and strengthening services for rural communities through strong documentation and compliance practices