Billing Compliance Auditor
- Dallas, TX
- $48,700-87,000 per year
- Permanent
- Full-time
- Responsible for performing internal coding audits and billing compliance reviews of various elements of physician billing for the organization.
- Works within specified third party payer and federal (CMS) coding/billing regulations.
- Develops training and education materials.
- Provides training and education to providers, clinical department and Revenue Operations staff.
- Provides other internal billing-related compliance services to the organization as required.
- Measures coding trends as compared to national standards.
- Review work samples from applicable reps/analysts to ensure quality/accuracy (e.g., billing processors, quality reps, collection reps).
- Demonstrate understanding of applicable quality review processes (e.g., corporate reviews, individual reviews, focus reviews, review to outcome analysis).
- Communicate audit/review findings to applicable stakeholders, as needed (e.g., Billing Operations, Customer Care, Optum).
- Respond to inquiries from applicable stakeholders (e.g., Quality groups, Billing Operations, Customer Care, vendors), and escalate as needed and take appropriate action.
- Review and ensure accuracy of audit reports prior to distribution to upper management.
- Provide support for external audit requests, as needed (e.g. Performant).
- High School Diploma / GED
- Must be 18 years of age OR older
- Certified Professional Coder required (one of the following: CPC, CCS, CPMA, CEMC or COC)
- 3+ years of experience in a physician/professional billing environment
- Experience with auditing physician chart utilizing E+M guidelines
- Experience with Microsoft Office Suite (Microsoft Excel, Microsoft Word, Microsoft Power Point) or successful completion of related course
- Must show proficiency in current billing software (EPIC) within six (6) months
- Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm EST. It may be necessary, given the business need, to work occasional overtime
- Great communication skills
- Ability to work independently and within a team
- Demonstrated experience with third party payer guidelines
- Provider education/Presentation Skills
- Utilize standard scoring (CMS) methodologies to report findings to providers
- Ability to employ clinical reference with the auditing process
- Apply CPT and ICD-10 coding convention to documentation guidelines
- Apply CMS and other payer constraints to final code and documentation determination
- Knowledge of medical terminology
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service