Compliance Auditor Sr

To be considered for the role, you must permanently reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Kentucky, Kansas, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia. Job Overview The Senior Compliance Auditor reviews complex audits, performs quality assurance reviews, acts as a peer mentor, and assists management with onboarding new auditors. The role supports audit supervisors with quarterly audit work plans and workflow processes, recommends process improvements, and contributes to special projects as needed. Responsibilities Perform complex audits of hospital and physician claims to ensure compliance with federal, state, local, and payer requirements. Develop and maintain audit schedules, software, and quality assurance reviews. Serve as team liaison for audit software maintenance and troubleshooting. Act as a peer mentor and train new auditors. Conduct two risk‑based audits per month. Provide compliance education sessions for internal coders and staff. Coordinate corrective action plans for identified non‑compliant issues and monitor their implementation. Assist with external audit analysis and trend tracking. Contribute to internal audit process manual development and participate in research or special projects. Perform other duties as assigned and support the mission of the Department. Qualifications Education: Bachelor’s Degree in Business, Finance, Allied Health, or other health‑related field from an accredited program (or equivalent combination of education and experience). Coding Certifications required: One of the following AAPC certifications — Certified Professional Coder (CPC), CPC‑H, CPC‑P, CPMA; or one of the following AHIMA certifications — Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist‑Physician Based (CCS‑P). Additional current coding certifications are preferred. Minimum of five (5) years of progressively responsible healthcare experience, including electronic health record analysis, data mining, audit and investigative work, risk analysis, and quality assessment. Comprehensive knowledge of CMS, OIG, and other regulatory guidelines for billing practices. Strong abilities in diagnosing and coding clinical services, using Microsoft Office, and advanced Excel. Preferred Experience Seven (7) years in risk auditing, coding review, and data mining. Five (5) years of hospital or physician‑related training experience. Working Conditions High‑stress environment with fluctuating workloads, occasional off‑site travel, and frequent interruptions. Prolonged periods of work alone and moderate physical demands (sitting). Environmental hazards include latex gloves, chemicals, moving parts, dust, fumes, electrical shock, and high‑pitched noise. Benefits Apply for opportunities within VCU Health. EEO Employer – Disabled – Protected Veteran – 41 CFR 60‑1.4. #J-18808-Ljbffr