Auditor

About the Role

The Auditor serves as a liaison between the practice, patients, and outsourced Revenue Cycle Management (RCM) providers. This role involves reviewing professional fee billing, coding, and documentation, as well as auditing physician billing practices against medical records to ensure compliance with federal, state, and third-party billing requirements.

Responsibilities

• Perform reviews and audits based on the current OIG Workplan and compliance risk analyses.
• Conduct timely and effective compliance and operational reviews to assess coding, documentation, and billing accuracy.
• Identify compliance risks and revenue capture opportunities.
• Determine corrections and refunds resulting from compliance audits and ensure completion.
• Analyze and identify areas for documentation improvement.
• Prepare written reports of findings.
• Provide education and training as needed.
• Perform follow-up reviews when necessary.
• Communicate findings and provide recommendations for improvement.
• Maintain up-to-date knowledge of governmental, state, and payer-specific rules and regulations related to documentation, coding, and billing.
• Field questions from coworkers and staff regarding coding and compliance issues.

Requirements

• Coding certifications (AAPC or AHIMA) and CPMA required.
• Strong knowledge of coding disciplines, medical terminology, and medical billing and payment methodologies, including coding guidelines for ICD-10, CPT, HCPC, and E/M.
• Comprehensive knowledge of procedure and diagnostic coding for professional services, as well as Medicare, Medicaid, and other third-party payer coding and billing regulations.
• Knowledge of 1995 and 1997 Evaluation and Management Documentation guidelines and other professional documentation requirements.
• Excellent verbal, written, and interpersonal communication skills.
• Strong computer skills, including proficiency in MS Office (e.g., Excel and Word).
• Ability to multi-task and meet multiple deadlines under pressure with initiative, diplomacy, and calmness.
• Knowledge and understanding of HIPAA rules and regulations.

Work Environment

This position is fully remote, but you must reside in one of the following states: Pennsylvania, Maryland, New Jersey, Delaware, Texas, Tennessee, West Virginia, Indiana, Georgia, Florida, or Ohio.

The employee is occasionally required to stand, walk, sit, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Schedule

Full-time, 8-hour shift, Monday through Friday.

Must be authorized to work in the U.S. for any employer.