• Perform comprehensive audits of facility and outpatient/professional claims for coding accuracy (i.e. CPT, HCPCS, ICD-10-CM/PCS, DRG, APC, and E/M levels) • Review clinical documentation and coding to ensure compliance with relevant payer policies, as well as applicable Federal and State regulations and coding guidelines. • Conduct education sessions for physicians and other qualified healthcare practitioners based on results of clinical documentation reviews • Review billing practices for facilities and practitioners across the continuum of care. • Perform independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. • Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations/practices/policies/guidelines to keep current with regulatory requirements and accepted compliance and audit practices. • Analyze paid claims data reports and develop risk informed audit plans. • Assist with development, review, and maintenance of compliance-related policies, procedures, and workplans. • Identify, assess, and escalate potential compliance risks, including billing, documentation, privacy, and regulatory concerns. • Assist clients with regulatory inquiries and payer reviews and participate in special compliance projects (e.g., external audit response, RAC review). • Analyze large data sets from EMR, billing systems, and audit tools to identify patterns, outliers, and compliance risks. • Develop dashboards and reports to present audit findings, trends, and actionable insights to leadership and compliance officers. • Recommend actionable improvements to policies, workflows, and coder/provider performance • Remain current with changing compliance and audit issues through ongoing education and outreach efforts. • Safeguard Protected Health Information (PHI) through adherence to HIPAA privacy and security standards in all documentation and communication • Perform other duties as assigned.