Senior Billing Compliance Auditor

Nicklaus Children's Hospital Careers; Miami (FL); On-site; USD 90,000 - 130,000; Full time

Job summary

Nicklaus Children's Hospital Careers seeks a Billing Compliance Auditor to support the hospital's Revenue Cycle by auditing professional and facility services for coding and documentation accuracy. This role ensures compliance with federal, state, and local regulations and hospital policies.

Responsibilities include auditing E/M levels, CPT/ICD-10/Modifier usage per AMA and CMS guidelines, DRG reviews, and QA of billing submitted to payers.

Qualifications

• 7-10 years of experience in coding and auditing professional fee and facility services.
• 2-4 years of experience with data mining audits.
• Bachelor's degree preferred; strong communication and independent work abilities.

Responsibilities

• Audits coding and documentation for professional fee and facility services.
• Audits validation of E/M level, CPT, ICD-10, and Modifier usage per AMA/CMS guidelines.
• Performs DRG coding reviews to verify accuracy and indicators for CMS requirements.
• Conducts quality assurance to ensure billing accuracy for federal/state payers.
• Analyzes review outcomes to identify trends and high-risk areas.
• Develops CAPA recommendations and documents findings in the case management system.
• Researches changes in coding and billing decisions; stays current on regulations.
• Performs follow-up audits to verify remediation of findings.
• Supports RAC requests and other external recoupment requests.

Education

CPC, CCS, RHIA, RHIT certification

Tools

EPIC

Job description

Nicklaus Children's Hospital Careers seeks a Billing Compliance Auditor to support the hospital's Revenue Cycle by auditing professional and facility services for coding and documentation accuracy. This role ensures compliance with federal, state, and local regulations and hospital policies.

Responsibilities include auditing E/M levels, CPT/ICD-10/Modifier usage per AMA and CMS guidelines, DRG reviews, and QA of billing submitted to payers.