Billing Compliance Auditor: Coding & CMS Specialist

Nicklaus Children's Health System; Miami (FL); On-site; USD 90,000 - 150,000; Full time

Job summary

Nicklaus Children's Health System is seeking an experienced Billing Compliance Auditor to review coding and documentation for professional and facility services. The role ensures compliance with federal, state, and local regulations and internal policies.

Key duties include conducting audits, validating E/M levels and CPT/ICD-10 usage, performing DRG reviews, and supporting RAC requests. Requires CPC/CCS/RHIA/RHIT and 7–10 years’ experience; EPIC proficiency is a plus.

Qualifications

• 7–10 years of experience in coding and auditing of professional fee and facility services.
• 7–10 years of experience with CMS and FL Medicaid regulations, including billing, coding and documentation rules.
• 2–4 years of experience with data mining audits.
• CPC/CCS/RHIA/RHIT certification required

Responsibilities

• Audits professional fee and facility services coding and documentation.
• Assesses E/M level, CPT, ICD-10, and modifiers per AMA and CMS guidelines.
• Performs DRG coding and clinical reviews for CMS/federal requirements.
• Conducts QA to ensure accuracy of billing to Federal and State payers.
• Analyzes outcomes to identify trends and high-risk areas; suggests CAPAs.
• Documents findings in case management system as part of CAPAs.
• Keeps knowledge up-to-date on national/local coding and billing decisions.
• Performs follow-up audits to ensure remediation of findings.
• Supports RAC requests and other external recoupment reviews.

Skills

Auditing

CMS regulations

Documentation accuracy

Education

CPC, CCS, RHIA, or RHIT certification

Bachelor's degree preferred

Tools

EPIC

Job description

Nicklaus Children's Health System is seeking an experienced Billing Compliance Auditor to review coding and documentation for professional and facility services. The role ensures compliance with federal, state, and local regulations and internal policies.

Key duties include conducting audits, validating E/M levels and CPT/ICD-10 usage, performing DRG reviews, and supporting RAC requests. Requires CPC/CCS/RHIA/RHIT and 7–10 years’ experience; EPIC proficiency is a plus.