Medical Auditor - Medical Bill Audit

About the role

This role is responsible for conducting medical record audits to validate the accuracy of hospital billing and ensure compliance with departmental charge policies and regulatory requirements. The Medical Auditor also identifies billing discrepancies, documentation gaps, and compliance risks, and recommends corrective actions to departmental leadership.

Responsibilities

• Conducts comprehensive medical record audits to validate accuracy of hospital billing and compliance with departmental charge policies.
• Reviews clinical documentation to ensure services billed are supported, complete, and compliant with regulatory and payer requirements.
• Identifies billing errors, documentation deficiencies, and compliance risks, and reports findings clearly and accurately.
• Analyzes audit results to identify trends or recurring issues and recommends corrective actions to departmental leadership.
• Represents the hospital in discussions related to billing, documentation, and reimbursement with third-party payers, patients, and hospital staff.
• Maintains detailed audit documentation in accordance with generally accepted audit practices and departmental standards.
• Stays current with changes in billing regulations, audit standards, and reimbursement guidelines impacting hospital operations.
• Participates in departmental and organizational performance improvement initiatives related to billing accuracy and compliance.
• Supports education and orientation efforts by providing audit-related guidance to clinical and revenue cycle staff as assigned.

Requirements

• Associate's Degree in Nursing or Technical Program
• Licensed Nursing Assistant required
• Registered Nurse or FL Practical Nurse licensure through the Florida Department of Health required
• Certified Medicaid Audit Specialist (CMAS) from American Association of Medical Audit Specialists (AAMAS) or Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders (AAPC) required
• Florida RN with 3 years recent clinical experience or LPN with 3 years auditing experience
• Medical audit experience required

Qualifications

• None specified

Skills

• Attention to detail
• Strong communication skills
• Knowledge of healthcare regulations and coding
• Ability to work independently and as part of a team

Benefits

• None specified

Pay

$67,288.00 per year

Schedule

Full-time, Monday through Friday, 8:00 am - 4:30 pm

Location

TGH Corporate Center