Senior Billing Compliance Auditor — Coding & Risk Insight

Boston Children’s Hospital; Boston (MA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Boston Children’s Hospital is seeking a Billing Compliance Auditor III to perform audits of clinical documentation and billing records. The role is hybrid and emphasizes accuracy, compliance, and process improvement.

The auditor will prepare reports, train staff, and help develop billing policies in coordination with CHB Foundations and Hospital leadership. Applicants should have a High School Diploma or GED, CPC or CCS-P certification, and at least three years of CPT/ICD-10 coding experience,

Qualifications

• Education: High School Diploma or GED required; higher education preferred.
• Certification: CPC or CCS-P (Professional Billing Coding) required.
• Experience: 3 years CPT and ICD-10 coding experience, incl. reviewing physician documentation.

Responsibilities

• Audit clinical documentation, physician billing and payment records for compliance with regulations and policy.
• Assess coding accuracy and risk; determine compliance with federal, state, and payer rules.
• Prepare reports and provide guidance to physicians and staff based on audit results.
• Draft billing and coding policies in coordination with Hospital leadership.
• Respond to external billing audit requests as needed.

Skills

CPT coding

ICD-10 coding

Documentation review

Auditing

Education

High School Diploma/GED

Associates or Bachelors preferred

Professional Billing Coding certification (CPC/CCS-P)

Job description

Boston Children’s Hospital is seeking a Billing Compliance Auditor III to perform audits of clinical documentation and billing records. The role is hybrid and emphasizes accuracy, compliance, and process improvement.

The auditor will prepare reports, train staff, and help develop billing policies in coordination with CHB Foundations and Hospital leadership. Applicants should have a High School Diploma or GED, CPC or CCS-P certification, and at least three years of CPT/ICD-10 coding experience,