Senior Compliance Coding Auditor at Wellpath

Franklin, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Sep, 26

Salary

0.0

Posted On

20 Jun, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Coding Audits, Medical Documentation Review, Risk-Based Sampling, CPT Coding, ICD-10-CM, HCPCS, CMS Guidance, E/M Auditing, Behavioral Health Coding, Vendor Oversight, Corrective Action Planning, Regulatory Compliance, Medicaid Coding Rules, Correctional Health Workflows, Audit Reporting, Provider Education

Industry

Hospitals and Health Care

Description

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports:• Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference The Sr Compliance Coding Auditor performs complex coding audits across a range of services, including those delivered in correctional settings and through third-party billing vendors. This role serves as a subject matter expert on coding and documentation guidelines, identifying risks and preparing detailed audit findings. The position works closely with leadership to develop corrective actions and deliver education to providers and coders. This role also supports regulatory audits and provides guidance and mentorship to compliance staff. Key Responsibilities Plan and conduct complex coding audits using risk-based sampling and established methodologies. Review provider documentation, coding, and modifier usage to ensure compliance with coding standards and payer rules. Analyze findings, prepare detailed audit reports, and present results to providers, coders, and leadership. Support corrective action planning, education efforts, and monitoring of compliance trends and regulatory updates. Provide guidance to compliance staff and support external audits, vendor oversight, and regulatory inquiries. Qualifications & Requirements Education Bachelor's degree in Health Information Management, Healthcare Administration, or a related field preferred Associate's degree with substantial equivalent professional coding and auditing credentials and experience may be considered Completion of formal coding and/or auditing training program (AAPC, AHIMA, or equivalent) required Experience Minimum five (5) years of progressively responsible experience in professional coding and coding audit Demonstrated experience performing complex E/M, primary care, chronic disease management, behavioral health, and/or medication-assisted treatment (MAT) audits using AMA CPT, ICD-10-CM, HCPCS, and CMS guidance Experience preparing detailed audit findings reports and presenting results to providers, coders, and operational leadership Working knowledge of OIG, CMS, AMA, and payer-specific compliance and documentation requirements Experience auditing or overseeing third-party billing vendors strongly preferred Familiarity with state Medicaid coding rules, Section 1115 Reentry Demonstration billing requirements, and correctional health workflows strongly preferred Previous correctional/detention facility coding or auditing experience preferred Licenses/Certifications Certified Professional Medical Auditor (CPMA) through AAPC — required, and/or Certified Professional Coder (CPC) — required, with Certified E/M Coder (CEMC) or Certified Professional Compliance Officer (CPCO) credential strongly preferred Certified Professional Biller (CPB) through AAPC — preferred, given the role's emphasis on third-party billing vendor oversight and government-program payer requirements Certified Coding Specialist (CCS) through AHIMA may be substituted for an AAPC equivalent We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Responsibilities

Perform complex coding audits across various services and correctional settings to ensure compliance with coding standards and payer rules. Identify risks, prepare detailed audit findings, and collaborate with leadership to implement corrective actions and provider education.