Regulatory Billing Auditor

  • MaineHealth
  • Portland, ME, USA
  • May 27, 2021

Job Description

Summary

  • Position Summary
    • Under the direct supervision of the Regulatory Billing Audit Manager the Regulatory Billing Auditor is responsible for performing selected medical audit reviews and analysis at the MaineHealth system level of clinical and technical records to support acceptable and compliant charging, billing and documentation practices for MaineHealth and its subsidiaries.

      This position demonstrates knowledge and experience within defined areas of regulatory billing, such as outpatient and physician practice billing, and works with the Regulatory Billing Manager and Senior Billing Auditors to expand their expertise to the full range of audits.

      The Auditor provides a statistical reports of findings and analysis in the form of an Executive Summary and may participate in communicating these finding to key leaders. The Auditor supports the analysis and recommendations that are used to evaluate compliance with the relevant healthcare regulations and provide technical and educational assistance to MaineHealth system leaders and various staff to ensure related process improvement.

  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: HS Education required. Secondary coursework in medical billing and coding is preferred.
    • License/Certification: 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.
    • Experience: Five or more years combined experience in coding, billing, documentation improvement, clinical practice, payer claims adjudication, and/or compliance Two to three years’ experience with medical auditing, research, and chart review is necessary.
      • Knowledge of physician and outpatient 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. The ability to research and analyze this information within the structure of a healthcare audit required.
      • Must have in-depth knowledge of medical and/or behavioral health practice organizational structure and/or outpatient hospital revenue cycle experience
    • Other Proficiencies:
      • A broad knowledge of medical terminology, anatomy and physiology, pathophysiology and disease process is required.
      • Ability to analyze and interpret clinical and administrative healthcare data and communicate at a college level, in both verbal and written formats.
      • Ability to organize and manage the extensive research, processing, collection, maintenance and analysis of compiled information and complete the preparation of reports from this data.
      • Ability to establish and maintain effective and ethical working relationships with physicians, administrators, supervisors, outside agency personnel, and all levels of hospital personnel in relation to appropriate documentation practices and compliance.
      • Ability to maintain the strictest confidentiality in the performance of duties.
      • Proficiency in Microsoft Office is required. Epic, or other healthcare EHR experience is preferred.
      • Ability to maintain the stamina, focus and accuracy required to perform detailed reviews and audits on a continuous basis.
      • Ability to work as scheduled, independently and in a team environment with some supervision and direction.

Additional Information

MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org