We are seeking a detail-oriented and analytical Billing Auditor to join our team. In this role, you will ensure the accuracy, completeness, and regulatory compliance of billing documentation across the revenue cycle.
Requirements
- Perform systematic reviews of claims billing to ensure quality, completeness, and accuracy throughout the revenue cycle.
- Conduct random patient encounter audits across various locations.
- Review audit work documents and admission documentation from the EHR for accuracy, completeness, and compliance with corporate policies and procedures.
- Plan and conduct audits related to revenue cycle processes or regulatory requirements, including Medicare and Medicaid compliance.
- Audit revenue cycle reports to verify accurate reporting of revenue, receipts, discounts, and related financial activity.
- Prepare clear and comprehensive audit findings for leadership.
- Analyze revenue cycle data to identify discrepancies, trends, and improvement opportunities while ensuring compliance with HIPAA, CMS, and other healthcare regulations.
- Provide detailed summary reports and supporting documentation for all audit outcomes.
- Ensure all appropriate billing charges are captured, documented, and reimbursed in accordance with policies, procedures, and regulatory requirements.
- Identify opportunities to strengthen charge capture processes, improve internal controls, and implement best practices to enhance compliance and revenue integrity.
- Respond to third-party audits, including charge recovery and regulatory audits.
- Provide training and education to clinical and program staff on documentation standards and charge capture processes.
- Uphold the organization’s Mission, Vision, Core Values, Philosophy of Care, and Code of Ethics in all interactions and decision-making.
- Maintain required training certifications, licensing, and regulatory accreditations.
- Communicate effectively with colleagues, individuals served, and family members when applicable.
- Cooperate fully with inspections and investigations conducted by state or licensing agencies.
- Maintain a safe, respectful environment, reporting any concerns related to safety, compliance, abuse, neglect, discrimination, or policy violations.
- Adhere to all laws, regulations, organizational policies, and ethical guidelines.
- Follow individual supervision requirements outlined in relevant care or service plans (e.g., IPP, ISP, IEP), when applicable.
Benefits
- Meaningful work that supports quality care and ethical operations.
- Collaborative environment committed to professional growth and continuous improvement.
- Opportunities to influence organizational practices and enhance compliance and revenue integrity.
