Quality Assurance Auditor

About the role

University Medical Billing (UMB) is a fully remote department viewed as the premier billing office for the University of Utah School of Medicine, serving over 1,800 providers and 30 different specialties across Utah and surrounding states. The department values collaboration, innovation, and accountability. The Quality Assurance Auditor conducts audits of medical coding to increase coding accuracy and identify opportunities for improvement and training. Responsibilities include reviewing audit results with medical coding management and staff, providing training on coding guidelines, medical terminology, and proper documentation techniques, and serving as a resource for coding standards and regulatory requirements. This is a mid-level support role completing routine tasks under moderate supervision.

Employment is contingent on successful completion of a background check and adherence to departmental policies, including UMB's Telecommuting Agreement which requires a distraction-free and HIPAA-compliant workplace, cameras on for all virtual calls/meetings, and the ability to work during office hours (Monday–Friday, approximately 8 a.m. to 5 p.m. Mountain Time) regardless of time zone. New hires must provide their own two monitors and reliable internet service.

Responsibilities

• Review and audit professional coding and billing from multiple medical and surgical departments and entities of University Health Care.
• Review billing and revenue cycle processes for accuracy and process improvements.
• Provide education based on clinical documentation requirements related to regulatory and reimbursement rules and regulations, reimbursement systems (federal, state, and payer-specific) and health insurance processing.
• Research coding, regulatory, and billing policies, background, and instructions as needed to ensure high-quality auditing, education, feedback, and subject-matter expertise development.
• Maintain an implicit understanding of the service line audited.
• Analyze data to find billing irregularities and modify audit scope.
• Identify inaccurate coding practices; prepare reports of findings and education on accurate coding practices, compliance risks, and revenue cycle efficiencies.
• Complete ad hoc related duties as assigned; meet performance standards and key performance expectations of the position.

Qualifications

Minimum qualifications: At least 1 year of directly related experience. (One year of higher education may be substituted for one year of directly related work experience; e.g., a bachelor's degree equals four years of directly related work experience.)

Required credentials and experience:

• CPC or AAPC certification.
• Minimum 6 years of coding experience with progressive coding experience in multiple specialties.
• Minimum 2 years of auditing experience.