Umpqua Health is recruiting for a Compliance Auditor, Quality to ensure the accuracy, integrity, and regulatory compliance of our care coordination, preauthorization, coding, billing, and documentation processes. In this critical role, you will conduct comprehensive audits, identify coding discrepancies, support quality assurance efforts, and provide education and training to improve accuracy and adherence to internal and external standards. This position supports the organization’s mission to deliver high-quality, compliant care while minimizing risk and improving operational efficiency through proactive monitoring, analysis, and collaborative improvement initiatives. 

Your Impact: 

• Conduct audits of clinical documentation, coding, and billing practices to assess compliance with CMS, AMA, and other regulatory standards. 
• Analyze medical records to identify trends in undercoding, overcoding, unbundling, or other compliance issues. 
• Develop and implement corrective action plans to address audit findings and improve compliance performance. 
• Collaborate with internal departments including Compliance, Care Management, and Revenue Cycle to promote coding best practices and mitigate risk. 
• Monitor coding patterns and provide strategic recommendations for quality improvement and process optimization. 
• Support the accuracy and compliance of care coordination and preauthorization workflows through targeted audits and feedback. 
• Provide ongoing education and training to clinical and administrative staff on documentation standards, coding guidelines (ICD-10, CPT, HCPCS, E/M), and regulatory updates. 
• Create and deliver educational materials, workshops, and presentations tailored to stakeholder needs. 
• Act as a subject matter expert and resource for coding and documentation-related inquiries. 
• Maintain accurate and comprehensive audit records, including findings, analysis, and follow-up actions. 
• Prepare detailed audit reports and present summaries to leadership and key stakeholders. 
• Assist with payer audit responses, appeals, and compliance inquiries as necessary. 
• Perform other duties as assigned to support Umpqua Health’s Vision, Mission, and Organizational Values. 

Your Credentials: 

• Current, active RN license or equivalent clinical background required. 
• Certified Professional Coder (CPC) credential or an equivalent coding certification is required. 
• Minimum of three (3) years of experience conducting medical audits, preferably within a healthcare compliance or quality assurance setting. 
• Proficient knowledge of ICD-10, CPT, HCPCS, and E/M coding guidelines; experience with inpatient coding is a plus. 
• Familiarity with federal and state regulations including CMS, HIPAA, OIG, and audit standards. 
• Experience in healthcare compliance, risk management, or revenue cycle operations preferred. 
• Technologically fluent with experience using electronic health records (EHR) and coding software platforms (e.g., Epic, Cerner, 3M, Optum). 
• Strong analytical skills and attention to detail in reviewing clinical documentation and identifying discrepancies. 
• Excellent verbal and written communication skills for delivering feedback, education, and audit reports. 
• Ability to work independently and collaboratively in a fast-paced, cross-functional environment. 
• Must be in good standing with all applicable regulatory bodies and not suspended, excluded, or debarred from participation in federal healthcare programs such as Medicare or Medicaid. 

About Umpqua Health

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.