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. This role involves evaluating medical coding, claim submissions, and reimbursement procedures to identify discrepancies, areas of improvement, and potential billing errors. The auditor will provide feedback to the billing team and healthcare providers to enhance billing accuracy, minimize risk, and maintain compliance with payer and regulatory requirements.
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.
· 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.