About the position Fairview is looking for a Senior Corporate Compliance Auditor to join our Corporate Compliance department. Bring Your Possibilities to Fairview. At Fairview, we believe in the power of possibility — within ourselves, our teams, and the communities we serve. We believe that leadership isn't just a title — it's a mindset we all share. Whether you're providing hands-on care, innovating behind the scenes, or supporting those who do, your work matters. The Senior Corporate Compliance Auditor is an independent, self-directed professional who possesses a blend of specialized knowledge and practical experience within coding, billing, and regulatory compliance for facility and/or professional services. The ideal candidate has a broad understanding of regulatory guidelines that are applicable to each government payment system, including the Prospective Payment Systems (PPS) for inpatient and outpatient hospital services and the Medicare Physician Fee Schedule (MPFS) applicable to professional services. Must be highly organized and possess professional and/or outpatient coding certifications with specific experience in auditing provider documentation, coding, and billing of professional and/or outpatient facility charges. Must possess strong analytic and critical thinking skills and be able to oversee complex projects from scoping and planning to reporting results. Must be able to work independently in a home office setting, is a researcher, problem-solver, and effective communicator, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment. A clinical background, e.g. RN, is a plus, as well as having experience related to coding, billing, and regulatory requirements for multiple specialties, including laboratory and behavioral health services.

Responsibilities

• Lead advanced, complex compliance audits and investigations with a primary focus on revenue cycle activities, including medical coding, billing, and documentation.
• Apply comprehensive knowledge of Medicare and Medicaid guidelines under the Medicare Physician Fee Schedule and the Outpatient Prospective Payment System.
• Demonstrate expertise in utilizing regulatory coding resources such as AMA E/M guidelines, CPT Assistant, NCCI, and AHA Coding Clinic relative to physician charges and facility outpatient charges.
• Review CPT, Level II HCPCS, and diagnosis codes to determine that regulations are being complied with as evidenced in medical record documentation and evaluate appropriateness of billing and coding procedures.
• Design compliance internal audit programs and perform various audit procedures to assess compliance with regulations, policies, and guidelines.
• Prepare audit workpapers with notation of regulatory documentation references utilized to support audit findings, evaluate test results, draw conclusions, and draft formal audit reports.
• Report audit results to stakeholders, including revenue cycle leadership and staff.
• Actively follow up on corrective action plans to validate completeness and risk mitigation and obtain adequate evidence to support closure of the open recommendation or compliance risk.
• Perform regulation research and organizational education.
• Provide consultative services to the organization's senior leadership, providers, and staff.
• Advise and assist with the development of the Corporate Compliance annual audit work plan, awareness, and mitigation of revenue cycle risks, and provide training and coaching to staff.
• Assist and advise Corporate Compliance team members with their audits, projects, and investigations.
• Possess data analytic and presentation skills.
• Maintain and promote all organizational and professional ethical standards.
• Be a high-level contributor and viewed as an expert internally.
• Independently complete assignments, manage audits and projects, perform regulatory research, investigate compliance issues, participate and collaborate in the Corporate Compliance internal audit process, provide documentation and compliance educational sessions to senior leadership, clinical staff, providers, revenue cycle leadership and staff, audit and monitor the quality and data integrity of Fairview's coding, documentation and billing practices.
• Communicate and interact with a wide cross-section of executive leaders, directors, managers, providers, and front-line staff to fulfill job requirements.

Requirements

• Bachelor's Degree in Health Information Management, Nursing, business administration, healthcare administration or related field or 8 years' experience with medical coding/billing auditing concepts.
• 8 years Active Coding experience.
• 2 years' experience with auditing concepts and principles.
• Knowledge of proper documentation of medical services and the electronic health record.
• Coding Certification, examples include: American Health Information Management Association (AHIMA), Registered Health Inform