Consultant - Healthcare Compliance Auditor - HTS

The Healthcare Compliance Auditor position is a staff consulting position within the Healthcare Transactions and Strategy (HTS) group. HTS performs regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, payers, and investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. This role requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. Job Responsibilities Plan and perform medical record audits to determine coding accuracy and compliant claims submission. Develop coding and documentation audit methodology using knowledge of key risk areas. Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and Centers for Medicare & Medicaid Services (CMS) coverage guidelines. Conduct analysis of audit findings to identify trends and problems in coding and documentation and effectively communicate findings and recommended areas for improvement. Serve as a subject matter expert on interpretation and application of coding and documentation guidelines. Monitor relevant resources, publications, and current government compliance and enforcement activity related to high‑risk compliance areas. Stay current on coding guidelines. Develop analyses using transactional or financial data. Generate client deliverables and contribute to expert reports. Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions. Participate in group practice meetings and contribute to business development initiatives and office functions such as staff training and recruiting. Prioritize assignments and responsibilities to meet goals and deadlines. Qualifications 4‑year degree (BS or BA). Active coding certification from either AAPC (CPC, CPMA) or AHIMA (CCC‑P, AOC) required. Minimum 2+ years of experience focusing on healthcare provider billing and coding; less than 10 years preferred. Preferred experience in physician practice coding (primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post‑acute coding (hospice, home health, SNFs). Preference for candidates who have previously worked in a consulting firm environment involving provider audits or transactional diligence audits. Preference for candidates who have worked in a health‑plan auditing role reviewing providers in the plan’s network. Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation. Advanced knowledge of CPT‑4, HCPCS, and ICD‑10‑CM coding systems, guidelines, and regulatory requirements. Ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools. Proficiency in Microsoft Office Suite (Excel, PowerPoint, Access, Word) and a desire to expand these capabilities. Strong analytical, time‑management, organizational, and prioritization skills. Exceptional verbal and written communication skills and a keen interest in healthcare compliance and policy. Ability to train others to use analytical tools and software. Candidate must be able to submit verification of legal right to work in the U.S. without company sponsorship. Consultant Salary Range: $70,000 – $150,000 We are an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law. #J-18808-Ljbffr LE001 Berkeley Research Group, LLC