Compliance Auditor-Ethics & Compliance
- Req ID: 34013
-
Address:
2500 Metrohealth DriveCleveland,OH
- Work Type: Full Time
- Date Posted: 8/7/2025
Location: METROHEALTH MEDICAL CENTER
Biweekly Hours: 80.00
Shift: 8a-4:30pm
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Job Summary:
Under the direction of the Compliance Supervisor - Audit (Doc and Coding) Services, conducts coding and documentation audits of MetroHealth (MHS) medical records to assess whether the documentation complies with applicable hospital and professional billing rules and regulations. Evaluates medical records to determine appropriateness of level of service, CPT/HCPCS, ICD-9, ICD-10 CM/PCS and revenue codes. Monitors enforcement activity and other indicators to assess risk of non-compliance for MHS. Collaborates with leadership to ensure the execution of an effective compliance program, including training on coding and documentation rules. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required:
Preferred:
Physical Demands:
Biweekly Hours: 80.00
Shift: 8a-4:30pm
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Job Summary:
Under the direction of the Compliance Supervisor - Audit (Doc and Coding) Services, conducts coding and documentation audits of MetroHealth (MHS) medical records to assess whether the documentation complies with applicable hospital and professional billing rules and regulations. Evaluates medical records to determine appropriateness of level of service, CPT/HCPCS, ICD-9, ICD-10 CM/PCS and revenue codes. Monitors enforcement activity and other indicators to assess risk of non-compliance for MHS. Collaborates with leadership to ensure the execution of an effective compliance program, including training on coding and documentation rules. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required:
- Bachelor's Degree in Health Care Administration, Business or related field and experience in coding, billing, and/or reimbursement.
- In lieu of degree, three to five years of equivalent work experience will be accepted.
- Certified AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association).
- Proficient in Microsoft Office (Word, PowerPoint and/or Visio).
- Advanced skills in Microsoft Excel.
- Strong quantitative and analytical skills.
- Excellent verbal and written communication skills.
- Excellent presentation skills.
Preferred:
- Additional certification such as CHC, CCS, etc.
- Working knowledge of Epic.
Physical Demands:
- May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating.
- May need to remain still for extended periods, including sitting and standing.
- Ability to communicate in face-to-face, phone, email, and other communications.
- Ability to read job related documents.
- Ability to use computer.
