Compliance Audit Specialist (Hybrid)

Job Requirements

Ensure Integrity. Drive Compliance. Join Our Team As Our Compliance Audit Specialist!

Location: Spartanburg, SC (Hybrid)

About Spartanburg Regional Healthcare System

Spartanburg Regional Healthcare System (SRHS) is a not-for-profit, integrated health network serving communities in South Carolina and North Carolina for over 100 years. With more than 10,800 employees and 1,000+ providers, SRHS delivers advanced care through multiple hospitals, specialty centers, and a Level I Trauma Center. Our mission: Advance health together.

Position Summary

The Compliance Audit Specialist plays a critical role in ensuring accurate coding, billing, and documentation compliance. This position partners with providers, coders, and leadership to conduct audits, monitor billing patterns, and deliver education. By providing oversight and expertise in coding regulations, you will help strengthen SRHS's Corporate Integrity Program and compliance initiatives.

Minimum Requirements

• High School Diploma or equivalent
• 1-3 years coding/billing experience for provider medical services
• CPC or CCS certification required
• Strong knowledge of CPT & ICD-10-CM guidelines
• Excellent communication and Microsoft Office skills

Preferred Qualifications

• Bachelor's degree
• 4+ years experience
• Familiarity with Epic, 3M Encoder, and coding tools
• RHIT or RHIA certification desirable

Key Responsibilities

• Conduct routine and focused audits of provider documentation and coding for compliance with CPT, ICD-10, and HCPCS guidelines
• Monitor billing patterns and identify potential compliance risks
• Develop and implement corrective action plans based on audit findings
• Provide education and training for providers, coders, and staff on documentation and coding standards
• Serve as a subject matter expert for procedural coding compliance
• Prepare and present compliance reports to leadership and stakeholders
• Maintain current knowledge of federal and state regulations, CMS guidelines, and OIG work plans
• Assist with investigations and resolution of coding-related complaints
• Develop educational tools and programs for resident physicians and clinical teams
• Promote compliance awareness throughout the organization
• Analyze audit outcomes and contribute to risk assessments for the annual Compliance Plan
• Collaborate with leadership and Corporate Integrity team on compliance initiatives
• Support development and revisions of auditing and monitoring plans based on trends and regulatory changes
• Act as a consultant to internal and external customers regarding documentation, coding, and billing issues

Join SRHS and help us protect integrity, ensure compliance, and support exceptional patient care. Apply today and make a difference!