Hospital Coding Compliance Auditor Job Description [Updated for 2025]

In the evolving world of healthcare, the focus on Hospital Coding Compliance Auditors has never been greater.

As medical practices evolve, the demand for meticulous professionals who can examine, maintain, and safeguard our healthcare coding systems intensifies.

But let’s delve deeper: What is genuinely expected from a Hospital Coding Compliance Auditor?

Whether you are:

• A job seeker trying to understand the core of this role,
• A hiring manager outlining the perfect candidate,
• Or simply captivated by the dynamics of hospital coding auditing,

You’re in the right place.

Today, we present a customizable Hospital Coding Compliance Auditor job description template, designed for straightforward posting on job boards or career sites.

Let’s dive right into it.

Hospital Coding Compliance Auditor Duties and Responsibilities

Hospital Coding Compliance Auditors are responsible for ensuring accurate and compliant medical coding within a hospital or healthcare facility.

They perform detailed audits, review medical records, and ensure adherence to relevant laws and regulations.

Their primary duties and responsibilities include:

• Reviewing and auditing medical coding data for accuracy, completeness, and compliance with regulations both federal and state.
• Conducting audits by reviewing patient records and comparing them to coded data.
• Providing feedback to coding staff on audit results and training them on correct coding practices.
• Reviewing, interpreting, and applying federal, state, and local policies and regulations related to medical coding and documentation.
• Identifying risk areas and conducting proactive audit activities.
• Working with medical staff to ensure accurate clinical documentation and patient records.
• Assisting in the development of compliance programs and corrective action plans.
• Maintaining up-to-date knowledge on coding guidelines and reimbursement reporting requirements.
• Creating reports of audit findings and presenting them to management and key stakeholders.

 

Hospital Coding Compliance Auditor Job Description Template

Job Brief

We are seeking a detail-oriented Hospital Coding Compliance Auditor to ensure that our coding and billing practices adhere to compliance standards.

The role involves reviewing and auditing medical billing and coding for processing, identifying any discrepancies, providing feedback, and ensuring corrective actions are taken to rectify errors.

The successful candidate will have a deep understanding of medical coding procedures, excellent analytical skills, and the ability to work independently.

The ultimate goal is to ensure that our organization adheres to legal standards and in-house policies, maintaining its business legality and ethical integrity.

 

Responsibilities

• Conduct regular audits of coding and billing data
• Identify and report any coding or billing discrepancies
• Provide feedback and guidance to coding staff on areas of concern and areas for improvement
• Assist in the development of compliance training materials and training sessions
• Stay up-to-date with changes in medical coding and compliance regulations
• Prepare and present reports on audit results
• Work with management to ensure corrective actions are implemented
• Ensure all company procedures and transactions comply with laws and regulations

 

Qualifications

• Proven experience as a Hospital Coding Compliance Auditor or similar role
• Knowledge of legal requirements in medical billing and coding
• Familiarity with industry practices and professional standards
• Excellent knowledge of reporting procedures and record keeping
• Methodical and diligent with outstanding planning abilities
• An analytical mind with problem-solving abilities
• Excellent communication skills
• Certification in Medical Coding (CPC) or similar is required
• Bachelor’s degree in Healthcare Administration, Health Information Management or relevant field

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Hospital Coding Compliance Auditor
• Work Environment: Hospital setting with occasional remote work. Some travel may be required for training or conferences.
• Reporting Structure: Reports to the Compliance Manager or Director of Health Information Management.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $65,000 minimum to $105,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Hospital Coding Compliance Auditor Do?

A Hospital Coding Compliance Auditor primarily works in the healthcare industry where they are responsible for maintaining the integrity and accuracy of clinical coding.

They review and audit medical records to ensure that all coding is accurate and complies with federal and state regulatory guidelines.

This includes ensuring that codes for diagnoses, treatments, procedures, and other aspects of patient care are properly logged and classified.

Their role involves working closely with other healthcare professionals, including physicians, nurses, and health information management specialists, to acquire necessary medical information and clarify any discrepancies in the patient records.

Hospital Coding Compliance Auditors also identify potential areas of compliance vulnerability and risk.

They develop and implement corrective action plans for resolution of problematic issues, and provide general guidance on how to avoid or deal with similar situations in the future.

They also provide training and education to the staff on coding issues and changes in coding standards and guidelines.

Ensuring that the hospital is in compliance with coding regulations helps to avoid legal complications, ensure accurate billing, and improve overall patient care.

 

Hospital Coding Compliance Auditor Qualifications and Skills

A professional Hospital Coding Compliance Auditor should possess the skills and qualifications that align with the job requirement, such as:

• An extensive knowledge of medical coding, including ICD-10, CPT, and HCPCS level II coding, as well as an understanding of medical terminology and healthcare regulations.
• Strong analytical skills to review and analyze medical records and billing documentation to ensure coding accuracy and compliance with federal and state regulations.
• Excellent communication skills to discuss coding discrepancies with physicians, coding staff, and other healthcare professionals, and provide training and education when necessary.
• Detail-oriented and meticulous nature to efficiently identify errors or inconsistencies in medical coding and billing processes.
• Auditing skills to review, correct, and validate coding of medical services, procedures, diagnoses, and treatments.
• High ethical standards and understanding of confidentiality requirements to handle sensitive medical data responsibly.
• Knowledge of electronic health records (EHR) and computer-assisted coding (CAC) systems.
• Ability to keep updated with changes in medical coding practices and healthcare laws to ensure compliance.
• Good interpersonal skills to work with a team of coding and billing professionals, and maintain a positive work environment.
• Problem-solving skills to resolve issues that arise during the auditing process.

 

Hospital Coding Compliance Auditor Experience Requirements

Hospital Coding Compliance Auditors are typically expected to have at least 3-5 years of experience in medical coding, preferably within a hospital setting.

This experience should involve using medical coding systems such as ICD-10, CPT, and HCPCS.

Many hospitals also expect candidates to have experience in coding audits, either by conducting them or being involved in the process.

This provides the necessary background to understand compliance and regulatory requirements, and the ability to spot discrepancies or errors.

Additionally, candidates with experience in healthcare compliance or healthcare regulations may be preferred.

This can include experience in roles such as Compliance Officer, Compliance Analyst, or similar roles within a healthcare setting.

Those with over 5 years of experience, and particularly those with leadership or managerial experience in coding or compliance, may be suitable for senior or supervisory positions.

Some hospitals may also value experience in training or mentoring others in coding and compliance procedures.

Lastly, experience with electronic health records (EHR) systems and health information management (HIM) systems can be beneficial for this role.

This allows for a seamless transition into managing and auditing digital health records.

Professional certification, such as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) designation, is also usually required or strongly preferred.

These certifications often require ongoing professional development and recertification, ensuring the auditor stays up-to-date with changing coding practices and regulations.

 

Hospital Coding Compliance Auditor Education and Training Requirements

A Hospital Coding Compliance Auditor typically requires a bachelor’s degree in health administration, health information management, nursing, or a related field.

They also need a strong understanding of medical terminology, anatomy, and physiology, as well as proficiency in ICD-10 and CPT coding systems.

Some positions may require individuals to have a Registered Health Information Technician (RHIT) or a Certified Professional Coder (CPC) credential.

In addition, they should have a comprehensive understanding of the healthcare compliance and auditing process, as well as the regulations and standards of agencies such as the Health Insurance Portability and Accountability Act (HIPAA) and the Centers for Medicare & Medicaid Services (CMS).

Many auditors also pursue a master’s degree in health administration or a similar field to further enhance their career prospects.

Continuing education is also crucial in this field, as regulations and standards frequently change.

Therefore, regular training and staying up-to-date with the latest industry trends and changes is essential.

Overall, obtaining further certifications, such as the Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) credentials, and gaining experience in healthcare billing or coding can significantly improve career prospects in this field.

 

Hospital Coding Compliance Auditor Salary Expectations

A Hospital Coding Compliance Auditor can expect to earn an average salary of $70,833 (USD) per year.

The actual salary can vary depending on factors such as years of experience in the field, certifications, and geographical location.

 

Hospital Coding Compliance Auditor Job Description FAQs

What skills does a Hospital Coding Compliance Auditor need?

Hospital Coding Compliance Auditors should have strong analytical skills to accurately identify coding and billing discrepancies.

They must have comprehensive knowledge of medical terminology, coding systems, and compliance regulations.

Good communication and interpersonal skills are also required as they will often need to liaise with healthcare providers, coding staff, and management.

 

Do Hospital Coding Compliance Auditors need a degree?

Most Hospital Coding Compliance Auditors are required to have a degree in health information management or a related field.

They also typically need to be certified as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS).

 

What should you look for in a Hospital Coding Compliance Auditor resume?

When reviewing a resume for a Hospital Coding Compliance Auditor, you should look for a degree in health information management or a related field and any relevant certifications.

Experience in coding or medical billing is also important, as is experience in auditing.

Knowledge of ICD-10-CM, CPT, and HCPCS coding systems is a must.

 

What qualities make a good Hospital Coding Compliance Auditor?

A good Hospital Coding Compliance Auditor is detail-oriented and thorough in reviewing coding data and medical records.

They must have a strong understanding of medical coding and compliance regulations and be able to stay updated on any changes in these regulations.

They should also be good communicators to effectively discuss their findings with different stakeholders.

 

Is it difficult to hire Hospital Coding Compliance Auditors?

Hiring Hospital Coding Compliance Auditors can be a challenge due to the specialized skill set required.

They need to have a deep understanding of medical coding systems and compliance regulations, as well as strong analytical skills.

However, offering competitive salaries and creating a supportive work environment can help attract qualified candidates.

 

Conclusion

And there you have it.

Today, we’ve unveiled the intricate details of a hospital coding compliance auditor‘s role.

Surprised?

It’s not just about analyzing data.

It’s about ensuring the highest standards of medical coding, one patient record at a time.

Armed with our comprehensive hospital coding compliance auditor job description template and real-world examples, you’re ready to take your next step.

But why stop there?

Dive deeper with our job description generator. It’s your essential tool for crafting precise job listings or refining your resume to absolute perfection.

Remember:

Every patient record is a part of the bigger picture in healthcare.

Let’s uphold that standard. Together.

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