Medical Billing Auditor
October 26
Description
• Job Summary: The Medical Billing Auditor is responsible for auditing and reviewing the billing practices of a medical practice to ensure accuracy, compliance with regulatory standards, and optimization of revenue cycle processes. • Key Responsibilities: • Audit Medical Billing Practices: Conduct thorough audits of medical billing processes, including coding accuracy, claims submission, payment posting, and account management. • Review Coding and Documentation: Ensure that medical coding (CPT, ICD-10, HCPCS) is accurate and matches the medical records and services provided by the healthcare team. • Compliance Monitoring: Verify compliance with federal, state, and payer-specific regulations, including HIPAA, Medicare, Medicaid, and private insurance billing standards. • Identify Errors and Discrepancies: Identify incorrect, incomplete, or inappropriate billing practices, claim denials, or underpayments, and work with the billing team to correct them. • Claims Analysis: Analyze the outcomes of claims submissions, including denied or rejected claims, and identify trends or patterns that may lead to non-payment or delays. • Provide Feedback and Recommendations: Offer constructive feedback to medical billing staff, healthcare providers, and administrators on how to improve billing practices, reduce errors, and increase efficiency. • Risk Management: Identify areas of risk for billing fraud, compliance issues, or revenue loss, and recommend corrective actions to mitigate these risks. • Prepare Audit Reports: Generate detailed audit reports summarizing findings, areas for improvement, and actionable recommendations to management and relevant stakeholders. • Educate and Train Staff: Provide training and education to the billing team and healthcare providers on best billing practices, coding updates, and regulatory changes. • Continuous Improvement: Stay current on billing regulations, payer policies, and medical coding updates. Implement audit processes and tools to improve auditing efficiency.
Requirements
• Bachelor’s degree in healthcare administration, business, accounting, or a related field (preferred). • Minimum [X] years of experience in medical billing, coding, or healthcare auditing. • Certified Professional Coder (CPC), Certified Medical Auditor (CMA), or equivalent certification (preferred). • Strong understanding of medical coding (CPT, ICD-10, HCPCS) and medical billing practices. • Knowledge of healthcare regulations, including HIPAA, Medicare, Medicaid, and private insurance payer requirements. • Experience with Electronic Health Records (EHR) systems and billing software. • Excellent attention to detail and analytical skills. • Strong communication and report-writing skills. • Ability to work independently and collaborate with billing and clinical staff. • Preferred Qualifications: • Experience auditing billing practices in a medical practice setting. • Certified Coding Specialist (CCS) or Certified Professional Medical Auditor (CPMA) credentials. • Familiarity with common billing software such as Epic, Cerner, or Medisoft.
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