Compliance Auditor

Job Description

Job Description

Full Time | On-Site/Remote Hybrid | Santa Ana, CA

Unites WestLabs (UWL) is seeking an experienced Compliance Auditor to support our growing revenue cycle and billing department.

Position Summary

The Compliance Auditor performs audits of laboratory orders, billing, coding, documentation, privacy practices, and operational workflows to ensure compliance with federal regulations, payer requirements, Medicare medical necessity guidelines, and company policies. The auditor identifies compliance risks, recommends corrective actions, and supports ongoing monitoring and education initiatives.

Essential Duties and Responsibilities

• Perform routine and targeted audits of laboratory services.
• Review physician orders, diagnoses, CPT coding, modifiers, and billing documentation.
• Conduct medical necessity audits utilizing Medicare NCD/LCD guidelines and payer policies.
• Audit privacy and HIPAA compliance processes.
• Analyze denial trends for compliance-related risks.
• Perform pre-bill and post-bill audits.
• Document findings and prepare audit reports.
• Develop corrective action plans and monitor implementation.
• Provide compliance education to staff and clients.
• Participate in risk assessments and compliance investigations.
• Assist with payer, client, and regulatory audits.
• Maintain audit schedules and compliance work plans.

Qualifications

• Bachelor's degree preferred.
• CPC, CPMA, RHIA, RHIT, CHC, or similar certification preferred.
• 3+ years healthcare compliance, coding, auditing, or revenue cycle experience.
• Knowledge of Medicare regulations, OIG guidance, HIPAA, and payer policies.
• Strong analytical and reporting skills.