The Corporate Integrity Senior Compliance Audit Specialist for Evaluation and Management (E&M) services serves in a consultative role supporting provider coding, billing, and education across the organization. This position strengthens provider documentation, coding, and billing compliance through auditing, monitoring, analysis of billing patterns, and ongoing advisory and educational support.
The role works in partnership with clinical providers, medical directors, leadership, coders, and other internal and external stakeholders. It plays an important part in supporting provider billing compliance and advancing Corporate Integrity Department initiatives and the annual work plan.
Key responsibilities include leading E&M compliance activities, developing and maintaining auditing and monitoring processes, serving as a subject matter expert, analyzing audit outcomes, creating corrective action plans, delivering education and training, and supporting compliance awareness across the organization.
Minimum requirements
- High school diploma or equivalent required
- 5-7 years of coding/billing experience for provider medical services
- Strong written and oral communication skills
- Ability to handle challenging conversations and provide effective provider education
- Proficiency with Microsoft Office products, including Word, Excel, PowerPoint, and Outlook
- Extensive knowledge of CPT and ICD-10-CM guidelines
- Self-directed with the ability to work independently and collaboratively
- CPC or CCS certification required
Preferred requirements
- Bachelor's degree preferred
- 8-10 years of experience preferred
- Experience with professional fee auditing, monitoring, and analysis, including provider utilization, statistical risk assessment, and report development
- Experience presenting and training on E&M guidelines and coding
- Familiarity with EPIC, E&M University, 3M Encoder, and related coding tools
- RHIT or RHIA certification highly desirable
Location
South Carolina, US
Employment Type
Part-time
Experience Level
Senior
Remote work allowed
No
Posted
2 months ago