Billing Compliance & Audit Analyst

Nicklaus Children's Hospital; Miami (FL); On-site; USD 85,000 - 110,000; Full time

Job summary

Nicklaus Children's Hospital in Miami, FL seeks a Billing Compliance Resource to monitor the Billing Compliance Program and ensure adherence to federal, state, and local regulations as well as internal policies. The role analyzes review outcomes, identifies trends, and develops CAPAs with actionable recommendations.

The candidate will conduct training, document education, and stay current on coding and billing changes.

Qualifications

• Bachelor's Degree required; CPC/CCS/RHIA/RHIT certification preferred.
• Experience with federal auditing regulations, including billing, coding and documentation requirements.
• Experience conducting data mining audits.

Responsibilities

• Analyzes Billing Compliance review outcomes and identifies trends and high-risk areas.
• Develops Billing Compliance audit activity and trends reports.
• Develops recommendations for CAPAs.
• Monitors and reports effectiveness of Billing Compliance training.
• Presents findings and education to improve billing/coding procedures.
• Documents training sessions and maintains records in case management system as part of CAPAs.
• Researches changes in national and local coding and billing procedures.
• Performs follow-up audits to ensure CAPAs.
• Supports review of RAC requests and other external recoupment requests.
• Collaborates with NCHS to identify process improvement strategies.

Skills

Billing compliance experience

HIM data analysis

Interdisciplinary teamwork

Independent work

Federal regulations knowledge

Data mining audits

Education

Bachelor's Degree

CPC

CCS

RHIA

RHIT

Tools

CERNER

Job description

Nicklaus Children's Hospital in Miami, FL seeks a Billing Compliance Resource to monitor the Billing Compliance Program and ensure adherence to federal, state, and local regulations as well as internal policies. The role analyzes review outcomes, identifies trends, and develops CAPAs with actionable recommendations.

The candidate will conduct training, document education, and stay current on coding and billing changes.