Remote Healthcare Billing & Compliance Auditor

Massachusetts General Hospital; Somerville (MA); Hybrid; USD 28,000 - 39,000; Full time

Job summary

Mass General Brigham is seeking a Billing Reviewer to conduct thorough reviews of healthcare billing and claims documentation. The role requires ensuring accuracy, regulatory compliance, and proper coding across ICD-10-CM, CPT, and HCPCS, while collaborating with providers to obtain necessary information.

The position supports auditing claims, resolving discrepancies, and addressing denials. A background in medical billing and EHR systems is essential for success in a HIPAA-compliant environment.

Qualifications

• High School Diploma or equivalent required.
• 1–2 years' experience in medical billing, claims processing, or coding.
• Knowledge of ICD-10-CM, CPT, HCPCS coding.
• Familiarity with HIPAA, CMS guidelines, and NCCI edits.
• Strong analytical skills and attention to detail.
• Proficiency with billing software and EHR systems.

Responsibilities

• Review medical claims and billing documentation for accuracy, completeness, and regulatory compliance.
• Verify appropriateness of billed services and codes.
• Identify potential compliance issues such as incorrect coding, upcoding, or unbundling.
• Conduct audits to ensure HIPAA and CMS adherence.
• Evaluate medical necessity of documentation supporting billed services.
• Collaborate with providers for information or clarification.
• Analyze claim denials, identify root causes, and suggest corrective actions.
• Work with billing and coding teams to resolve discrepancies and resubmit claims.
• Identify potential fraudulent activities or abuse in billing practices.

Skills

Coding knowledge (ICD-10-CM, CPT, HCPC

Auditing & compliance

Analytical skills

Communication skills

EHR proficiency

Education

High School Diploma or Equivalent

Tools

Billing software

Electronic Health Records (EHR)

Job description

Mass General Brigham is seeking a Billing Reviewer to conduct thorough reviews of healthcare billing and claims documentation. The role requires ensuring accuracy, regulatory compliance, and proper coding across ICD-10-CM, CPT, and HCPCS, while collaborating with providers to obtain necessary information.

The position supports auditing claims, resolving discrepancies, and addressing denials. A background in medical billing and EHR systems is essential for success in a HIPAA-compliant environment.