Senior Billing Compliance Auditor (CPT/ICD-10 & DRG)

Nicklaus Children's; Homestead (FL); On-site; USD 95,000 - 120,000; Full time

Job summary

Nicklaus Children’s Hospital in Florida seeks a Billing Compliance Auditor to audit coding and documentation for professional and facility services, ensuring compliance with federal, state, and local regulations as well as hospital policies.

Responsibilities include auditing CPT/ICD-10, validating E/M levels, DRG reviews, and conducting quality assurance for payer submissions. Strong CMS/Medicaid knowledge and data-mining audit experience are required.

Qualifications

• CPC, CCS, RHIA or RHIT certification required.
• 7-10 years of experience in coding and auditing of professional and facility services.
• 7-10 years handling CMS and Florida Medicaid billing, coding and documentation rules.
• 2-4 years of experience with data mining audits.

Responsibilities

• Audits professional and facility billing coding for compliance.
• Reviews E/M level, CPT, ICD-10 and modifiers per AMA and CMS.
• Performs DRG coding reviews and validates clinical indicators.
• Conducts quality assurance for billing to federal/state payers.
• Analyzes review outcomes and identifies high-risk areas.
• Develops CAPA recommendations and documents findings in the system.
• Keeps current on national/local coding and billing decisions.
• Performs follow-up audits to verify remediation.
• Supports RAC and external recoupment requests review.

Skills

Auditing

Healthcare coding

Data analysis

CMS regulations

Communication

Education

CPC/CCS/RHIA/RHIT certification

Bachelor's degree preferred

Tools

EPIC

Job description

Nicklaus Children’s Hospital in Florida seeks a Billing Compliance Auditor to audit coding and documentation for professional and facility services, ensuring compliance with federal, state, and local regulations as well as hospital policies.

Responsibilities include auditing CPT/ICD-10, validating E/M levels, DRG reviews, and conducting quality assurance for payer submissions. Strong CMS/Medicaid knowledge and data-mining audit experience are required.