Auditor

About the position

Are you passionate about ensuring accuracy and compliance in medical billing and coding? Do you thrive in a collaborative environment where your expertise can make a significant impact? If so, we have the perfect opportunity for you! This person will play a crucial role in maintaining the integrity of our medical billing and coding practices. Your keen eye for detail and deep understanding of healthcare regulations will help us stay compliant and efficient.

Responsibilities

• Auditing Medical Records: Review medical records to ensure coding accuracy and compliance with healthcare regulations (e.g., ICD-10, CPT, HCPCS codes). Verify that documentation matches billed procedures and services.
• Compliance Monitoring: Ensure billing practices comply with federal, state, and payer-specific guidelines, including HIPAA and CMS regulations. Monitor external audits and regulatory focus to develop an internal audit plan. Collaborate with the Compliance Department on potential fraud, abuse, or coding inaccuracies that may lead to compliance risks.
• Trend Analysis: Analyze data to detect and report errors in coding, billing, or documentation. Report and document key findings, recommend corrective action procedures, and track their implementation. Identify patterns and trends to provide recommendations for process improvement.
• Education and Training: Create educational materials for medical coders, billers, and healthcare providers on coding standards, billing practices, and compliance requirements. Conduct regular workshops or one-on-one sessions to address recurring issues.
• Collaboration: Work closely with coding teams, revenue cycle departments, and healthcare providers to resolve identified issues. Collaborate with compliance officers and auditors to improve workflows.
• Policy Development: Develop or revise billing and coding policies to meet regulatory requirements.

Requirements

• Bachelor's degree in healthcare administration or a related field.
• 5+ years of auditing experience in healthcare billing and coding.
• Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) required.
• Strong knowledge of ICD-10, CPT, HCPCS, and DRG coding systems.
• In-depth understanding of healthcare laws and regulations (e.g., HIPAA, CMS guidelines) and third-party payer requirements, specifically Medicare.
• Exceptional attention to detail and analytical skills for identifying discrepancies.
• Proficiency with auditing tools, EHR systems, billing software, and Microsoft Office Suite.
• Collaborative style that emphasizes communication, service, transparency, and teamwork.
• Excellent analytical and problem-solving abilities.
• Outstanding written and verbal communication skills, with the ability to present data and translate complex issues into comprehensible ideas.
• Demonstrated commitment to diversity, equity, and inclusion.

Benefits

• Impactful Work: Your efforts will directly contribute to maintaining the highest standards of compliance and accuracy in our billing and coding practices.
• Professional Growth: Opportunities for continuous learning and development through workshops and training sessions.
• Collaborative Environment: Work with a team that values collaboration, communication, and transparency.
• Remote Flexibility: Enjoy the flexibility of working from a HIPAA-compliant home office.