Healthcare Billing Auditor & Compliance Reviewer (Remote)

Partner's Healthcare; Somerville (MA); Hybrid; USD 27,000 - 39,000; Full time

Benefits offered by this job

Comprehensive benefits

Career advancement opportunities

Bonuses as applicable

Job summary

Mass General Brigham Incorporated is seeking a Healthcare Billing Reviewer to conduct thorough reviews of medical billing and claims documentation. The role ensures accuracy, regulatory compliance, and proper coding across various payer policies.

You will verify codes, identify compliance gaps, and collaborate with providers and billing teams to resolve issues. The position emphasizes HIPAA compliance, auditing practices, and timely submission of corrected claims within a remote/hybrid work

Qualifications

• In-depth knowledge of ICD-10-CM, CPT, HCPCS and payer requirements.
• Familiarity with HIPAA, CMS guidelines and NCCI edits.
• Strong analytical skills and attention to detail in reviewing billing documents.

Responsibilities

• Review medical claims and billing for accuracy and compliance.
• Verify appropriateness of billed services and codes.
• Identify potential compliance issues and auditing needs.
• Collaborate with providers to obtain required information.
• Analyze denials and suggest corrective actions.
• Work with billing teams to resolve discrepancies and resubmit as needed.
• Identify potential fraud or abuse in billing practices.
• Report suspicious activities to compliance teams.

Skills

Medical billing knowledge

HIPAA/CMS guidelines

Analytical skills

Billing software proficiency

EHR systems proficiency

Communication skills

Education

High School Diploma or Equivalent

Tools

Billing software

EHR systems

Job description

Mass General Brigham Incorporated is seeking a Healthcare Billing Reviewer to conduct thorough reviews of medical billing and claims documentation. The role ensures accuracy, regulatory compliance, and proper coding across various payer policies.

You will verify codes, identify compliance gaps, and collaborate with providers and billing teams to resolve issues. The position emphasizes HIPAA compliance, auditing practices, and timely submission of corrected claims within a remote/hybrid work