Senior Regulatory Billing Auditor

Description

The Senior Regulatory Billing Auditor role is responsible for providing comprehensive medical audit review and analysis of clinical and technical records to support acceptable and compliant charging, billing and documentation practices. This Senior-level position demonstrates knowledge and experience to be responsible for the full range of audits, including complex audits of a sensitive and confidential nature, encompassing inpatient, outpatient and facility billing.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: High School diploma or GED preferred. Associate or Bachelor's Degree in a related field preferred.
2. License/Certifications: Must possess one or more of the following certifications: CPC, COC, RHIT, RHIA, CCS, or CCS-P. Additional certifications including CPMA, CHC, or CPCO are preferred.
3. Experience: Eight years of combined experience in coding, billing, documentation improvement, clinical practice, payer claims adjudication, and/or compliance required. Three years of experience with medical auditing, research, and chart review required.
4. Additional Skills/Requirements Required: Experience demonstrating knowledge of physician and hospital billing practices, CMS regulations, CPT coding guidelines from the American Medical Association, ICD-10-CM, as well as knowledge of the AHA Coding Clinic, commercial payer guidelines, state and federal healthcare regulatory guidance required. Knowledge of ICD-10-PCS along with DRG methodology,
5. Additional Skills/Requirements Preferred: In-depth knowledge of teaching hospital, provider-based medical and behavioral health practice organizational structure. CAH, RHC, Home Health and FQHC experience preferred.

If you have questions about this role, please contact Leanne M. Roberts at leanne.roberts@mainehealth.org