Billing Compliance, Senior Auditor

NorthShore University HealthSystem

Evanston (IL)

Hybrid

USD 41,328 - 63,369

Full time

14 days+

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Benefits offered by this job

Annual increases based on performance

Career pathways for growth

Medical, dental, vision options

Tuition reimbursement

Free parking

Wellness program savings

Health Savings Account options

Retirement options with company match

Paid time off & holidays

Job summary

NorthShore University HealthSystem is seeking a Senior Auditor for Billing Compliance to conduct audits, analyze coding and billing documentation, and support investigations across the medical group and system facilities. The role requires strong knowledge of ICD-10-CM/PCS, CPT/HCPCS, and Medicare/Medicaid rules, with EPIC experience highly preferred.

Hybrid work arrangement (Evanston, IL and remote) with flexible hours and opportunity for professional growth within a leading health system.

Qualifications

Bachelor's degree required and RHIA/RHIT or nursing with coding certification (CCS, CPC) desired.
3+ years in regulatory billing compliance and hospital/professional revenue cycle.
Experience with EPIC strongly preferred.

Responsibilities

Conduct comprehensive retrospective and prospective coding, billing, and documentation audits.
Analyze notes and billing docs to ensure coding accuracy and regulatory compliance.
Audit ICD-10-CM, CPT/HCPCS codes for appropriateness against records and rules.
Lead internal investigations related to billing concerns and external inquiries.
Identify trends and risks; communicate findings and drive corrective actions.
Document audit activities and support regulatory readiness.
Calculate reimbursement impact and overpayment estimates using Excel.
Support audit responses with data validation and documentation.
Communicate results across clinical, operational, and compliance teams.
Maintain current knowledge of ICD-10-CM/PCS, CPT/HCPCS, and Medicare updates.

Skills

medical coding

compliance research

investigative analysis

CMS policy interpretation

Excel (data analysis, pivot, VLOOKUP/X

Microsoft Word

Education

Bachelor's degree

Tools

EPIC

Job description

Hourly Pay Range:

$30.46 - $45.69 – The hourly pay rate offered is determined by a candidate’s expertise and years of experience, among other factors.

Billing Compliance, Senior Auditor

Reporting to the Manager of Billing Compliance, this position supports the Corporate Compliance Program by conducting routine audits and investigations related to coding, billing, documentation, and operational quality assurance processes that impact payer reimbursement for medical services. The Senior Auditor applies corporate policy, payer contract requirements, and federal and state regulations to identify, communicate, and resolve risks affecting claim payment, in partnership with administrative and clinical leadership.

Position Highlights:

Position: Billing Compliance, Senior Auditor
Location: Hybrid (Evanston, IL and remote)
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 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.
- EPIC experience, strongly preferred
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)