Auditor for Clinical Compliance and Coding Excellence

6 days ago


Annapolis, Maryland, United States Insight Global Healthcare Full time

Insight Global Healthcare is seeking a highly skilled Auditor to support its large healthcare system based in Annapolis, MD. As a key member of the Patient Financial Services department, this role will play a crucial part in ensuring the accuracy and integrity of clinical documentation and billing processes.

Job Overview

The successful candidate will conduct thorough audits of medical records, coding, and billing practices to guarantee compliance with regulatory standards and internal policies. This involves analyzing coding-related denials, developing process improvements, and collaborating with clinical staff, coders, and financial services personnel to identify discrepancies and implement corrective actions.

Key Responsibilities
  • Coding Audits: Conduct comprehensive reviews of medical records to verify the accuracy of clinical documentation and coding.
  • Denial Analysis: Analyze coding-related denials to identify trends and root causes, and develop strategies to prevent future denials.
  • Process Improvements: Develop and implement process improvements for coding and documentation workflows based on denial analysis and industry guidelines.
  • Billing Compliance: Review billing practices to ensure compliance with federal, state, and local regulations, as well as hospital policies.
  • Discrepancy Identification: Identify and report discrepancies, errors, and potential areas of risk in clinical documentation and billing.
  • Education and Training: Collaborate with clinical staff, coders, and financial services personnel to provide education and training on proper documentation and coding practices.
  • Corrective Action Plans: Develop and implement corrective action plans to address identified issues and improve overall compliance.
  • Audit Reporting: Prepare detailed audit reports and present findings to the Director of Patient Financial Services and other relevant stakeholders.

The ideal candidate will possess a strong background in coding and auditing, excellent analytical and problem-solving skills, and the ability to work effectively in a team environment. In return, Insight Global Healthcare offers a competitive salary of $85,000 - $110,000 per year, depending on experience, plus a range of benefits and opportunities for professional growth.



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