Professional Billing Auditor – Surgical Specialty

This is a fully remote position, open to applicants in United States.

📋 Description

• Offer continuous audit assistance for physician billing in hospital settings, emphasizing intricate surgical services.

• Conduct retrospective and/or concurrent audits of professional billing claims related to surgery.

• Analyze operative reports and relevant documentation to ensure correct assignment of CPT, HCPCS, and ICD-10-CM codes.

• Confirm the appropriate use of modifiers and bundling in line with NCCI edits and payer regulations.

• Detect trends in surgical coding, compliance risks, and areas for enhancement.

• Deliver clear and educational feedback to professional billing coders regarding surgical coding precision.

• Record audit results and suggestions in alignment with established auditing standards.

• Assist in the preparation for internal and external audits concerning professional fee surgical services.

• Maintain adherence to CMS, AMA, and specific payer billing regulations.

⛳️ Requirements

• At least 2+ years of experience in professional billing auditing, focusing on surgical services.

• In-depth knowledge of CPT (Surgery section), ICD-10-CM, modifiers, and NCCI edits.

• Experience in auditing surgical billing claims for hospital-based physicians.

• CPC, CPMA, or an equivalent certification is preferred.

• Excellent written and verbal communication skills, with the capability to provide constructive feedback on audits.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive healthcare coverage including medical, dental, and vision.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork and collaboration.