Auditor

• Support the Coding and documentation quality assurance (CDQA) team
• Implementation of and compliance with enterprise-wide and department coding policies and procedures for PHS
• Compliance to all external regulatory agency coding rules and regulations
• Perform and/or manage on-site internal audits or reviews to assess compliance/quality monitoring
• Serve as a resource on documentation, coding, billing, and coding compliance questions
• Develop and present educational programs and information dissemination
• Audit and training support for coding, audit, and physician personnel identified as low performers
• Perform medical record and billing reviews of denied and appealed claims
• Coordinate review and tracking of appealed claims and communication with affected payers
• Research and interpret all regulatory agency regulations

Pro Fee Auditor/Educator

• Audit execution & oversight by performing routine and ad hoc audits across the full revenue cycle process, including: Charge entry and charge capture accuracy, CPT, HCPCS, and ICD-10 coding compliance, Modifier usage, Workers’ compensation billing rules and state-specific fee schedules, Claim submission accuracy and clean claim rates, Payment posting and adjustment accuracy, AR follow-up effectiveness and denial resolution workflows
• Conduct pre-bill and post-bill audits to identify trends impacting reimbursement and compliance
• Denial & Revenue leakage analysis: Analyze denial trends across WC, Medicare, and commercial payers, Identify root causes of denials and recommend corrective actions, Quantify revenue impact from: Coding errors, Missed charges, Underpayments, Inefficient workflows
• Ensure adherence to: CMS guidelines and Medicare billing requirements, NCCI (CCI edits) and payer-specific edits, State Workers’ Compensation regulations, Documentation standards for pain management procedures
• Support internal and external audit readiness (RAC, MAC, payer audits).
• Reporting & KPI development through audit dashboard Maintain monthly & quarterly records of all RCM, clinical, and provider audit scores and training requirements
• Partner with all BHC teams to develop and deliver targeted education based on audit findings.
• Assist in creating and updating SOPs and workflows to reduce errors and improve efficiency
• Establish and maintain quality assurance programs across RCM functions
• Perform routine QA reviews of staff productivity and accuracy
• Recommend automation opportunities and system enhancements
• Assumes other responsibilities as appropriate to the position and organizational needs

RCM Auditor

• Perform financial statement audits for nonprofit and governmental organizations
• Participate in audit planning, fieldwork, testing, and reporting
• Build strong relationships with clients throughout audit engagements
• Collaborate with experienced team members to deliver high-quality work
• Depending on experience, supervise staff and manage audit engagements

• Perform regularly scheduled in plant audits as requested by the Regional Inspection Manager.
• Perform on-site scheduled audits as requested by Regional Inspection Manager.
• Perform product sampling as requested by Regional Inspection Manager.
• Continually monitor the client’s implementation of approved quality systems.
• Continually evaluate and communicate the status of each client’s quality system to the Regional Inspection Manager.
• All inspection reports will be sent to the Regional Inspection Manager for review by the end of each month.
• Establish excellent relationships with States and HUD to ensure we are respected as a leader and partner.
• Ensure all applicable ICC NTA procedures are consistently followed in the execution of inspection jobs.
• Continually identify, recommend, and pursue opportunities for process improvements within the Department and ICC NTA.

Quality Auditor – Building Inspection

• Conduct audits to evaluate compliance with a wide variety of Federal and State laws, regulatory rules & regulations, PSJH policies and procedures.
• Collaborate with Case Management, Utilization Review, Revenue Integrity, Clinical Risk, Internal Legal Affairs and Finance under supervision.
• Navigate and analyze data across Clinical EMR and Epic Billing systems, reviewing line-item charges and supporting documentation.
• Present audit findings collaboratively to reduce risk within Providence as a system.

Auditor jobs in New Mexico

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Pro Fee Auditor/Educator

RCM Auditor

Auditor

Quality Auditor – Building Inspection

Compliance Auditor