Senior Regulatory Billing Auditor

MaineHealth; Westbrook (ME); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Senior Regulatory Billing Auditor to join their team. This fully remote position involves conducting thorough audits of clinical and technical records to ensure compliance with billing practices. The ideal candidate will have extensive experience in coding, billing, and medical auditing, along with a strong understanding of CMS regulations and coding guidelines. This role offers the opportunity to work with dedicated healthcare professionals who prioritize community service and support. Join a team that values flexibility, professional growth, and a commitment to exceptional care.

Benefits

Paid Parental Leave

Flexible Work Policy

Student Loan Assistance

Training and Education Resources

Well-being Resources

Qualifications

• 8+ years of experience in coding, billing, and compliance.
• 3+ years of experience in medical auditing and chart review.

Responsibilities

• Conduct comprehensive medical audit reviews and analyses.
• Ensure compliance with billing and documentation practices.

Skills

Coding

Billing

Documentation Improvement

Compliance

Medical Auditing

Knowledge of CMS Regulations

CPT Coding Guidelines

ICD-10-CM

Education

High School diploma or GED

Associate or Bachelor’s Degree

Job description

Fully Remote

The Senior Regulatory Billing Auditor role is responsible for providing comprehensive medical audit review and analysis of clinical and technical records to support acceptable and compliant charging, billing, and documentation practices. This senior-level position demonstrates knowledge and experience to be responsible for the full range of audits, including complex audits of a sensitive and confidential nature, encompassing inpatient, outpatient, and facility billing.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: High School diploma or GED preferred. Associate or Bachelor’s Degree in a related field preferred.
2. License/Certifications: Must possess one or more of the following certifications: CPC, COC, RHIT, RHIA, CCS, or CCS-P. Additional certifications including CPMA, CHC, or CPCO are preferred.
3. Experience: Eight years of combined experience in coding, billing, documentation improvement, clinical practice, payer claims adjudication, and/or compliance required. Three years of experience with medical auditing, research, and chart review required.
4. Additional Skills/Requirements: Experience demonstrating knowledge of physician and hospital billing practices, CMS regulations, CPT coding guidelines from the American Medical Association, ICD-10-CM, as well as knowledge of the AHA Coding Clinic, commercial payer guidelines, and state and federal healthcare regulatory guidance required. Knowledge of ICD-10-PCS along with DRG methodology.
5. Preferred Skills/Requirements: In-depth knowledge of teaching hospital, provider-based medical, and behavioral health practice organizational structures. CAH, RHC, Home Health, and FQHC experience preferred.

Additional Information

With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with healthcare professionals who truly value the people around them – both within the organization and in the communities they serve.

We offer benefits that support individual needs today and flexibility for tomorrow – including paid parental leave, a flexible work policy, student loan assistance, training, education, and well-being resources for you and your family.

MaineHealth is committed to investing in our care team and fostering an inclusive environment where you can thrive and reach your full potential. If you’re interested in building a career in a place where people support each other to deliver exceptional care, apply today.

If you have questions about this role, please contact Leanne M. Roberts at [e-mail].