Overview:
Concentra is recognized as the nation’s leading occupational health care company.
With more than 40 years of experience, Concentra is dedicated to our mission to improve the health of America’s workforce, one patient at a time. With a wide range of services and proactive approaches to care, Concentra colleagues provide exceptional service to employers and exceptional care to their employees.
The Clinical Services Auditor is responsible for conducting comprehensive audits of occupational health and therapy billing services to ensure adherence to federal, state, and organizational compliance standards. Operating under the direction of the Compliance & Coding Audit Manager, the role supports Concentra’s compliance framework by identifying risk, promoting billing integrity, and ensuring accurate and compliant documentation and billing practices.
Responsibilities:
- Perform scheduled and ad hoc audits of occupational health and therapy billing, coding, and documentation, with emphasis on services billed to payors.
- Evaluate occupational health and therapy-related coding for accuracy, medical necessity, timebased coding compliance.
- Assess compliance with applicable federal and state regulations, payor-specific guidelines, and Concentra’s internal policies.
- Identify and document billing discrepancies, coding variances, and potential compliance risks, including over coding, under coding and insufficient documentation.
- Prepare detailed audit reports outlining findings and recommendations for leadership review.
- Provide structured feedback and education to therapy providers, physicians, and non-physician providers to enhance documentation quality and coding accuracy.
- Collaborate with the Compliance & Coding Audit Manager to support annual audit plans and compliance initiatives.
Qualifications:
- Education Level: High School Diploma or GED
- Certifications and/or Licenses: Professional certification: Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) with the intention of becoming certified as CPMA within 1 year
- Has at least 2 years of experience in coding and compliance auditing
- Proficiency in CPT, ICD-10, HCPCS, and therapy specific time-based coding methodologies
- Demonstrated knowledge of payor regulations and requirements
- Experience with electronic health record (EHR) systems and billing platforms
- Exceptional analytical, organizational, technical, and communication skills
- Ability to work independently and collaboratively across different departments
- Prior experience with therapy services and occupational health services preferred but not required
- Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
- Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
- Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
- The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
- Coding and auditing experience
- Moderate to advanced computer skills with programs such as PowerPoint, Word, Excel, Access and similar databases
- Working knowledge of routine and non-routine concepts, practices and procedures within billing and coding
- Excellent process and time management skills
- High degree of accuracy and attention to detail
- Organized and ability to analyze multiple sources of data
- Proficient written, oral communication
- Work independently and as part of a team
- Able to multi-task
- Ability to meet multiple deadlines
- Expertise in scheduling and facilitating Training and presentation skills (in person and virtual)
- Familiarity with state specific workers' compensation regulations
- Coding analytics experience
Additional Data:
Employee Benefits
- 401(k) Retirement Plan with Employer Match
- Medical, Vision, Prescription, Telehealth, & Dental Plans
- Life & Disability Insurance
- Paid Time Off
- Colleague Referral Bonus Program
- Tuition Reimbursement
- Commuter Benefits
- Dependent Care Spending Account
- Employee Discounts
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation, if required.
*This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management*
Concentra is an equal opportunity employer that prohibits discrimination, and will make decisions regarding employment opportunities, including hiring, promotion and advancement, without regard to the following characteristics: race, color, national origin, religious beliefs, sex (including pregnancy), age, disability, sexual orientation, gender identity, citizenship status, military status, marital status, genetic information, or any other basis protected by federal, state or local fair employment practice laws.