Provider Documentation, Billing Auditor

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

📋 Description

• Execute independent audits and assessments of provider documentation, coding, billing, and reimbursement practices.

• Assess the accuracy, completeness, and adequacy of clinical documentation in accordance with coding, billing, medical necessity, regulatory, payer, and organizational standards.

• Conduct ongoing surveillance to pinpoint compliance risks, billing vulnerabilities, coding trends, and opportunities for process enhancement.

• Detect potential overpayments, underpayments, coding errors, documentation shortcomings, and other compliance issues.

• Suggest corrective measures and aid in the prevention of documentation and billing challenges.

• Collaborate with compliance personnel, providers, advanced practice providers, revenue cycle teams, operational leaders, and various departments.

• Deliver education and training on documentation needs, coding standards, billing regulations, compliance expectations, and best practices.

• Act as a subject matter expert in documentation integrity, coding, billing compliance, reimbursement criteria, and regulatory changes.

• Support the development, review, and revision of policies, procedures, and internal controls.

• Keep accurate audit workpapers, documentation, reports, and records.

• Monitor shifts in healthcare laws, regulations, payer guidance, coding requirements, and industry standards while evaluating their impact on the organization.

• Foster integrity, ethical behavior, accountability, and regulatory compliance throughout the Mary Free Bed system.

• Undertake other responsibilities and special projects as assigned by the Compliance Officer.

• Exhibit excellent customer service, promote and oversee service standards, encourage teamwork, communicate openly, and manage confidential information with sensitivity.

• Identify issues, seek solutions, and contribute to quality improvement and customer service monitoring initiatives.

• Report directly to the Compliance Officer.

⛳️ Requirements

• Bachelor’s degree or higher in health information management, healthcare administration, nursing, or a related field.

• 2–5 years of experience in provider coding and billing for professional services.

• Experience in auditing Evaluation and Management (E/M) services.

• Experience in auditing CPT coding.

• Experience in auditing ICD-10-CM diagnosis coding.

• Experience in auditing HCPCS Level II coding.

• Experience in auditing modifier usage.

• Experience in auditing Medicare and commercial payer requirements.

• Experience in auditing documentation requirements that support billed services.

• Extensive knowledge of healthcare compliance policies, programs, practices, standards, and related compliance matters.

• Advanced understanding of compliance and auditing principles, theories, and concepts.

• Familiarity with billing procedures and systems.

• Proven experience in customer service principles with diverse groups of individuals.

• Strong organizational, communication, and complex problem-solving capabilities.

• Proficiency in computers and application software.

• Ability to work autonomously and with minimal supervision.

• Capacity to function effectively and adapt in high-stress and fast-paced environments.

• Ability to collaborate as an effective team member.

• Ability to maintain the confidentiality of MFB Health records and systems.

• Auditing, Compliance, Healthcare billing and/or coding certification is preferred.

🏝️ Benefits

• Remote work opportunities available within the United States.

• Temporary position covering a leave of absence.

• Reasonable accommodations for qualified applicants or employees with disabilities.

• Commitment to equal opportunity employment.