Senior Regulatory Billing Auditor

MaineHealth; Kingston; On-site; CAD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking healthcare organization as a Senior Regulatory Billing Auditor, where you will play a crucial role in ensuring compliance and accuracy in billing practices. This position requires a deep understanding of medical auditing and billing regulations, along with a collaborative spirit to work with healthcare professionals dedicated to community impact. With opportunities for professional growth and a commitment to inclusivity, this role is perfect for those looking to make a significant difference in patient care and support a thriving work environment. Embrace the chance to advance your career while making a positive impact on healthcare delivery.

Benefits

Paid Parental Leave

Flexible Work Policies

Student Loan Assistance

Training and Education Resources

Well-being Resources

Qualifications

• 8+ years of experience in coding, billing, and compliance required.
• Must possess certifications like CPC, COC, RHIT, RHIA, CCS.

Responsibilities

• Conduct comprehensive medical audit reviews and analysis.
• Oversee a range of audits, including complex and sensitive audits.

Skills

Medical Auditing

Billing Practices

CPT Coding Guidelines

ICD-10-CM Knowledge

Healthcare Regulatory Guidance

Education

High School Diploma or GED

Associate or Bachelor's Degree

Tools

CMS Regulations

ICD-10-PCS

Job description

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 oversee 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: 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, and state and federal healthcare regulatory guidance. Knowledge of ICD-10-PCS along with DRG methodology is also required.
5. Preferred Skills: In-depth knowledge of teaching hospital, provider-based medical and behavioral health practice organizational structures. Experience with CAH, RHC, Home Health, and FQHC settings is preferred.

Additional Information

Working across MaineHealth locations in Maine and New Hampshire, you'll collaborate with healthcare professionals who value teamwork and community impact.

We offer benefits supporting current needs and future planning, including paid parental leave, flexible work policies, student loan assistance, training, education, and well-being resources for you and your family.

MaineHealth is dedicated to investing in our care team and fostering an inclusive environment where you can thrive and reach your full potential. If you're interested in building a career where people support one another to deliver exceptional care, apply today.

If you have questions about this role, please contact Leanne M. Roberts at [e-mail]