Billing Compliance Analyst - Audit & Process Improvement

Miami Children’s Hospital; Miami (FL); On-site; USD 70,000 - 100,000; Full time

Job summary

Miami Children’s Hospital seeks a Billing Compliance Analyst to support the Billing Compliance Program. The role monitors activities to ensure adherence to federal, state, and local regulations and organizational policies, and to identify trends for remedial action.

The candidate will develop audit activity and CAPA recommendations, analyze outcomes, and provide guidance to improve billing and coding procedures. Team collaboration and record-keeping are essential.

Qualifications

• Bachelor's degree required.
• Certified Coder (CPC/CCS/RHIA/RHIT) preferred.
• 4–7 years in billing compliance or related fields.
• Knowledge of federal auditing regulations (billing, coding).
• Experience with data mining audits.

Responsibilities

• Analyses Billing Compliance review outcomes and identifies trends.
• Develops billing compliance audit activity and trends reports.
• Develops CAPA recommendations.
• Monitors and reports effectiveness of training.
• Presents findings and provides guidance to improve billing/coding procedures.
• Maintains training records in the case management system.
• Researches changes in coding and billing procedures.
• Performs follow-up audits.
• Supports RAC requests and external recoupment requests.
• Collaborates with NCHS members to identify process improvements.

Skills

Billing compliance

Auditing regulations

Data mining audits

Healthcare revenue cycle

Education

Bachelor's Degree

CPC

CCS

RHIA

RHIT

Tools

CERNER

Job description

Miami Children’s Hospital seeks a Billing Compliance Analyst to support the Billing Compliance Program. The role monitors activities to ensure adherence to federal, state, and local regulations and organizational policies, and to identify trends for remedial action.

The candidate will develop audit activity and CAPA recommendations, analyze outcomes, and provide guidance to improve billing and coding procedures. Team collaboration and record-keeping are essential.