Compliance Auditor

What Ethics & Compliance contributes to Cardinal Health

Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.

Job Summary

The Compliance Auditor is responsible for conducting coding, documentation audits to ensure adherence to regulatory requirements, payer policies, and organizational standards. This position focuses primarily on Medical Oncology, Radiation Oncology and Urology services and requires advanced knowledge of CPT, HCPCS, ICD-10-CM, reimbursement methodologies, and healthcare compliance regulations.

The Compliance Auditor performs detailed claim reviews, identifies coding and documentation risks, analyzes trends, develops recommendations for improvement, and delivers education to providers, coders, and operational teams. The ideal candidate enjoys analyzing complex claims and medical records, possesses exceptional attention to detail, can identify broader compliance and operational implications, and demonstrates a strong commitment to collaboration, education, and continuous improvement.

Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and abilities required. The successful candidate will possess advanced knowledge of healthcare coding, auditing, and compliance principles, with demonstrated expertise in Medical Oncology, Radiation Oncology, and Urology services. The ideal candidate is detail-oriented, analytical, committed to accuracy and continuous learning, and able to effectively balance detailed audit review with broader compliance risk assessment. Strong collaboration and communication skills are essential.

Conduct coding, billing, and documentation audits to identify compliance, coding, and reimbursement risks.

Review medical records and claims to ensure compliance with regulatory, payer, and organizational requirements.

Analyze audit findings, identify trends and opportunities for improvement, and recommend corrective actions.

Prepare audit reports and communicate findings to leadership, providers, coders, and operational stakeholders.

Provide education and guidance to physicians, coders, and staff on coding, documentation, compliance requirements, and industry best practices.

Research coding and documentation questions to support accurate code assignment and reimbursement.

Assign and validate ICD-10-CM, CPT, HCPCS, and modifier usage for professional and facility services as applicable.

Coordinate responses to external audit and medical record requests and ensure timely submission of required documentation.

Maintain current knowledge of coding guidelines, payer policies, and healthcare regulations impacting Medical Oncology, Radiation Oncology, and Urology services.

Collaborate with Compliance, Revenue Cycle, Coding, Clinical, and Operational teams on monitoring activities and compliance initiatives.