Senior Auditor, Billing Compliance

🌍 Remote, USA 💹 Full-time 🕐 Posted Recently

Job Description

About the position

Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments.
Analyze source documents and associated billing documentation for coding and billing accuracy.
Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation.
Conduct internal Compliance investigations in response to external concerns.
Identify trends or patterns of questionable coding and billing practices and report issues to Manager.
Communicate incidental findings identified in audits for potential future investigation.
Document relevant findings for all audits and investigations conducted.
Calculate reimbursement impact and statistical error rates based on findings in audits and investigations.
Facilitate communication of audit and investigational activities between internal/external customers.
Keep current on topics related to coding, billing, and documentation requirements.
Work on special projects related to Billing Compliance as assigned.

Bachelor's degree required.
Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC) required.
3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
Experience with analyzing and/or auditing Revenue Cycle functions, including ICD-10, CPT, and HCPCS coding accuracy.
Experience with compliance auditing, facility and physician coding/billing practices, and PPS systems of payment preferred.

Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.
Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, and practice management.