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.