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Compliance Auditor, Billing & Coding

Location: Pittsburgh, Pennsylvania
Work Setting: Non Provider Setting
Job Function:
Auditor, Coder, Coding – Auditor
Job Type:
Salary Range: $25.49-$44.12


Do you have a strong coding background and are looking for the next step in your career that offers some work from home flexibility?  Look no further!  UPMC Corporate Services is hiring a Compliance Auditor, Billing & Coding role.

Job Description

The position will assist the Office of Ethics, Compliance and Audit Services in executing coding compliance auditing and monitoring efforts for UPMC. The position will support UPMC’s compliance program through risk identification and assessment of coding and billing processes.


Under the Director of Health Services Compliance, the position conducts risk-based coding quality audits of inpatient and outpatient pre, post and acute care encounters to validate that code assignment follows the official coding guidelines as supported by clinical documentation in the health record. The incumbent is also expected to contribute to the implementation and success of ongoing department goals.


  • Conducts UPMC wide auditing and monitoring of medical record documentation to ensure the documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards.
  • Validates the ICD-10-CM and ICD-10-CM-PCS codes and DRG assignment appropriateness to ensure consistency and efficiency in inpatient claims processing, data collection, and quality reporting.
  • Conducts audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy
  • Communicate to key stakeholders regarding audit findings and corrective actions, if necessary. Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations. Advise revenue cycle and senior leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations.
  • Works on joint projects with OECAS staff to resolve coding, billing and documentation issues and act as the expert on billing and coding related topics.
  • Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement methods.

Required Qualifications

  • Bachelor’s Degree in Business Administration, HIM, Health Administration, Nursing is required.
  • 5 or more years of experience in healthcare auditing and medical coding and billing.
  • Extensive knowledge of CMS, Medicaid, and third-party payer coding, billing and compliance regulations required (MS-DRG, APR-DRG, APC, APG, ICD10-CM, HCPCS, CPT, Modifiers, etc.). 
  • In depth knowledge of coding/classification systems appropriate for inpatient, outpatient, and DRG prospective payment system.
  • Experience in an academic medical center setting is strongly preferred.
  • Extensive knowledge of key revenue cycle processes, clinical documentation and financial operations is strongly preferred.
  • Data Analytics experience is strongly preferred.
  • Expert proficiency with associated technology solutions such as Microsoft Excel, Word and Access is strongly preferred.
  • Ability to identify, interpret and summarize relevant policy and regulation in a clear and timely manner is essential.
  • Experience researching and interpreting regulation and performing internal investigations is essential.
  • Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.
  • Ability to work in a fast-paced environment is a must.
  • Must have ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
  • Attention to detail is critical to the success of this position as is the ability to deal with ambiguity.
  • Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.

Licensure, Certifications, and Clearances:
CCS, CIC, or CMC Required

Certified Coding Specialist (CCS)

Certified Inpatient Coder (CIC)

Certified Medical Coder (CMC)

Preferred Qualifications

Inpatient Coding

Certified Coding Specialist (CCS)

Certified Inpatient Coder (CIC)

Certified Medical Coder (CMC)

Education Qualifications

  • Bachelor’s Degree in Business Administration, HIM, Health Administration, Nursing is required.

Instructions for Resume Submission

Please submit your application at:

Apply Online:

Posted: September 3, 2020 at 10:37 AM
Post ID: 53927

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