Billing Compliance, Senior Auditor

Endeavor Health; Evanston (IL); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Opportunity for annual increases based on performance

Career Pathways for professional growth

Various Medical, Dental, and Vision options

Tuition Reimbursement

Free Parking

Wellness Program Savings Plan

Health Savings Account Options

Retirement Options with Company Match

Paid Time Off

Community Involvement Opportunities

Job summary

A healthcare organization in Evanston, IL is seeking a Senior Auditor for Billing Compliance. Responsibilities include conducting comprehensive audits, analyzing billing documentation, and ensuring coding accuracy. Candidates must have a Bachelor's degree, relevant certifications (RHIA, RHIT, or nursing with coding certification), and at least 3 years of experience in regulatory billing compliance. The position offers opportunities for professional growth and various benefits including medical options, tuition reimbursement, and paid time off.

Qualifications

• 3+ years of experience in regulatory billing compliance or revenue cycle.
• Extensive experience in compliance audits and analyzing Revenue Cycle functions.
• Strong communication skills to convey complex coding and compliance information.

Responsibilities

• Conduct coding, billing, and documentation audits across facilities.
• Analyze source documents to ensure billing accuracy.
• Lead internal compliance investigations for billing concerns.
• Maintain documentation of audit activities to ensure regulatory compliance.
• Facilitate communication of audit results across teams.

Skills

Medical coding

Compliance research

Investigative analysis

Microsoft Excel

Interpreting clinical documents

Communication

Education

Bachelor's degree

RHIA or RHIT certification

Nursing with coding certification (CCS, CPC)

Tools

Microsoft Excel

Microsoft Word

Job description

Position Highlights

• Position: Billing Compliance, Senior Auditor
• Location: Evanston, IL
• Full Time/Part Time: Full-time
• Hours: Monday-Friday, during normal business hours
• Required Travel: travel to other sites may be required for meetings

What You Will Do

• Conduct comprehensive retrospective and prospective coding, billing, and documentation audits across the medical group and all system facilities.
• Analyze source documents (including progress notes, operative reports, pathology reports, etc.) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related records) to ensure coding and billing accuracy.
• Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation, applying appropriate corporate policies, state and federal regulations, coding rules, commercial payer guidelines, and Medicare/Medicaid standards (e.g., NCDs, LCDs, Medicare Manuals, and DRG/APC/RBRVS/other relevant Prospective Payment System billing rules).
• Lead and support internal Compliance investigations in response to billing concerns and external inquiries, including high-risk scenarios requiring timely, thorough, and confidential review.
• Identify trends, patterns, and potential risks in coding and billing practices; communicate findings and escalates issues for further investigation and corrective action.
• Maintain comprehensive documentation of audit and investigation activities, including interviews, claim reviews, control assessments, root cause analysis, and corrective action plans, ensuring audit readiness and regulatory compliance.
• Calculate reimbursement impact, statistical error rates, and overpayment estimates using Microsoft Excel, incorporating data mining, validation techniques, and extrapolation methodologies as needed.
• Support internal and external (government and payer) audit activities by preparing documentation, validating data, and assisting in audit responses.
• Facilitate communication of audit and investigational results across clinical, operational, and compliance teams to support resolution and process improvement.
• Maintain current knowledge of coding, billing, and regulatory requirements, including annual updates to ICD-10-CM/PCS and CPT/HCPCS, and Medicare regulatory updates.

What You Will Need

• Education: Bachelors degree, required
• Certification: RHIA or RHIT or nurse with coding certification (CCS, CPC), required
• Experience: 3+ years with focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
  • Extensive experience conducting compliance audits, and analyzing Revenue Cycle functions, including ICD-10, CPT, and HCPCS coding accuracy. Medicare Policy requirements, and the operational workflows affecting hospital and physician billing.
• Unique or Preferred Skills:
  • Skilled in medical coding, compliance research, and investigative analysis, with the ability to apply regulatory and coding updates to audit findings and corrective action initiatives.
  • Proficient in interpreting a variety of clinical documents, CMS policies, third-party payer guidelines, and government regulations, ensuring audits are accurate, thorough, and aligned with compliance requirements.
  • Strong communication skills, with the ability to convey complex coding and compliance information effectively to non-coding staff across clinical, operational, and administrative teams.
  • Advanced Microsoft Excel (data analysis, pivot tables, VLOOKUP/XLOOKUP, data validation, reporting)
  • Proficient in Microsoft Word (audit reports, documentation, formatting, templates)

Benefits

• Opportunity for annual increases based on performance
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

EOE: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.