Billing Auditor (Hybrid)

Position Summary:

The Billing Auditor is responsible for performing systematic reviews to ensure quality, completeness in the documentation and accuracy in the revenue cycle including medical, dental, hospital and/or pharmacy claims billing. Prepares audit findings for the Director of Revenue Cycle, Training Manager, Patient Services & Eligibility management, Chief Financial Officer, and Corporate Compliance.

This position is intended to be a hybrid role, where the incumbent will be expected to rotate between remote & on-site work every other week. Additional on-site presence may be required based on business need.

Essential Functions of the Job:

• Conducts random patient encounter audits for each Clinic location.
• Prepare audit work documents from the Electronic Health Record (EHR) system and the Electronic Practice Management (EPM).
• Review registration documentation for completeness, accuracy and compliance per Corporate Policies and Procedures.
• Monitors sliding affordability performance monthly by service line, (Medical, Dental and Pharmacy).
• Providing monthly reports on nominal fee collection rates for each sliding fee service category.
• Provide a comprehensive summary report and support documentation of the audit finding results in an Excel Spreadsheet.
• Analyze audit findings and Electronic Practice Management reports to identify trends, patterns or variations regarding clinics or end user compliance with documentation requirements per Corporate Policies and Procedures.
• Communicate the results of the audit findings via written report and/or oral presentation to the Director of Revenue Cycle, Training Manager, Patient Services & Eligibility management, and Chief Financial Officer.
• Assist in the development of end user specific training, as well as corrective action plans based on the audit findings.
• Track and identify trends and risk areas based on audit findings and data analysis.
• Maintains all records and data logs of the monthly audits performed.
• Demonstrates knowledge and understanding of the services provided and programs offered.
• Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws.
• Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates.
• The ability to read and interpret contract language is an essential function of the Billing Auditor.
• Attends meeting and training classes as required by departmental or facility management.
• Will be called upon to perform special projects and participate in external audits that may require some evening and weekend hours.
• Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety, and infection control standards.

Additional Duties and Responsibilities:

• All duties assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors.

Job Requirements

Experience Required:

• The Billing Auditor must have a minimum of 3 years’ experience in a medical billing department.
• Must also demonstrate knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology.

Education Required:

• High School Diploma or GED equivalent. 

Verbal and Written Skills Required to Perform the Job:

• Good oral and written communication skills.
• Provides positive customer service skills.
• Must possess the ability to communicate effectively in English, both verbally and in all written communication.

Technical Knowledge and Skills Required to Perform the Job:

• Experience in billing, CPT codes, and ICD-10, as well as Medical terminology. 

Equipment Used:

• General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.

Working Conditions and Physical Requirements:

• This position is intended to be a hybrid role, where the incumbent will be expected to rotate between remote & on-site work every other week. Additional on-site presence may be required based on business need.
• Sedentary work requires sitting and use of the PC most of the day.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment.  Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.