2. Develop and execute risk-based audit plans.

3. Conduct pre- and post-payment audits for documentation and billing accuracy.

4. Coordinate with external auditors and internal departments.

5. Educate providers on compliance, coding, and billing guidelines.

6. Investigate complaints and respond to compliance inquiries.

7. Maintain current knowledge of healthcare regulations and payer requirements.

8. Communicate audit findings and support corrective actions.

9. Lead due diligence compliance efforts for mergers, acquisitions, and joint ventures.

10. Supervise internal and external audit activities and reporting.

11. Collaborate across departments to improve revenue cycle processes.

1. Experience in teaching hospital or pediatric healthcare settings required.

2. Strong background in physician-based coding and billing.

3. Familiarity with Medicaid/Medicare regulations.

4. Skilled in audit procedures, data analytics, and compliance training.

5. Proficient in Epic, Excel, Word, and healthcare billing systems.

6. Strong communication and organizational skills.

Education and Experience

1. Education: High School Diploma Required. Bachelor's degree preferred, or 8 years of relevant experience for the role.

2. Certification: CPC or CCS-P required; CPMA preferred.

3. Years of relevant experience: Minimum 7 years in hospital and professional coding.

4. Years of supervisory experience: Minimum 2 years in a leadership role.