The Compliance Billing Auditor reviews physician claims and related medical records to verify accuracy, completeness, and compliance with coding standards, insurance requirements, and healthcare regulations. Physician Billing Audits are a critical function in healthcare organizations, ensuring that physician claims are accurate, compliant, and supported by proper documentation. The Compliance Billing Auditor involves reviewing medical records, coding, and billing data to identify discrepancies, ensure regulatory compliance, and improve financial integrity.
Department Summary The Compliance Billing Auditor will work closely with Compliance Officers, Office Managers, Physicians, Providers and Billing personnel to review billing and operational data to determine compliance with federal, state laws and regulations. The Compliance Billing Auditor reports directly to the Physician Office Compliance Officer. Qualifications High School Diploma or equivalent.
Certification as a CPMA, CPC, CPCO, CPB, CPC-H, or CCS-P. Two years experience with coding and reimbursement for physician services. Billing experience would be helpful, but not required.
Knowledge of physician auditing practices and an in-depth knowledge of CPT and ICD-10-CM diagnosis codes and HCPCS procedure and professional supply codes used for billing services provided by physicians and non-physician providers. Department Qualifications Skills Skill in establishing and maintaining effective working relationships with physicians and mid-level providers. Ability to communicate in writing.
Interpersonal communication and facilitation skills. Knowledge of a variety of computer software applications in word processing, spreadsheets, database and presentation software (MSWord, Excel, Access, PowerPoint). Able to complete projects within specific timeframes.
Displays a warm, courteous and helpful demeanor when dealing with internal and external customers. Displays flexibility and cooperation in situations involving change or implementation of new procedures. Department Skills Attendance, promptness, professionalism, the ability to pay attention to detail, cooperativeness with co-workers and supervisors, and politeness to customers, vendors, and patients.
Ability to work independently, organizes work procedures, and assumes responsibility with minimal direction from Compliance Officer after orientation period. Responsibilities & Expectations Audit medical records to validate documentation supports E/M services, procedures, diagnosis, and ancillary services and to identify opportunities or gaps. Research regulatory guidelines and requirements to support findings, when necessary Prepare audit summary findings report that includes detailed comments to support audit findings.
Provides individual educational sessions with physicians to discuss audit results and provide recommendations where warranted. Keeps current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues. Provides training and education on coding, documentation and other compliance issues to physicians, non-physician providers, and staff on an ongoing basis.
Track and log provider education. Research various compliance and documentation issues. Responds to and track third party inquiries regarding level of service coding by the physicians.
Distributes the Aultman Compliance Program to all persons and entities identified as involved in documenting, coding and billing for services within the designated group. Serves as a liaison between coding and billing personnel and physicians. Assists with monthly report preparation of audit and education activities.
Develops tools for physician use to aid with documentation and billing, as requested. Other duties or special projects as assigned. Department Responsibilities & Expectations Working Conditions 8:00am – 5:00pm M-F or hours as required by the job.
Occasional weekends and off -shifts. Subject to frequent interruptions and changes in priority of duties throughout the day. Hybrid/WFH schedule available.
Local travel is required. Hazardous Exposure Category Category III - Includes tasks that involve no exposure to blood, body fluids, or tissues and Category I tasks are not a condition of employment. The normal work routine involves no exposure to blood; body fluids or tissues (although situations can be imagined or hypothesized under which anyone anywhere might encounter potential exposure to body fluids.) Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid or to be potentially exposed in some other way.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation or protected veteran status. The organization is an EEO/AA Employer Disability/Vet. The organization will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on the organization or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation.
Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Aultman Human Resource Department and request such an accommodation.
Day Shift · 8-5