The posting
This is a limited duration role to cover for a leave of absence.
Position is eligible for remote work within the United States.
Summary
The Provider Documentation and Billing Auditor is responsible for conducting independent audits, reviews, and monitoring activities related to provider documentation, coding, billing, and reimbursement practices across the Mary Free Bed system. This role evaluates compliance with organizational policies and procedures, federal and state laws and regulations, payer requirements, and applicable coding and billing standards to help ensure the integrity of provider services and revenue cycle operations.
The Auditor assesses existing documentation, coding, and billing processes to identify compliance risks, control gaps, operational inefficiencies, and opportunities for improvement. Through audit findings, data analysis, and collaboration with clinical, operational, and provider leaders, the Auditor develops recommendations to strengthen internal controls, enhance documentation accuracy, improve billing compliance, and support appropriate reimbursement.
A key responsibility of this position is to identify, investigate, correct, and help prevent documentation and billing issues through ongoing monitoring, education, and proactive compliance initiatives. The Auditor serves as a subject matter resource for providers, advanced practice providers, leadership, and staff regarding documentation integrity, coding accuracy, billing requirements, and regulatory expectations.
The Provider Documentation and Billing Auditor plays a critical role in promoting a culture of integrity, accountability, and compliance throughout the organization by fostering awareness of regulatory requirements and supporting continuous improvement efforts. This position reports directly to the Compliance Officer.
Essential Job Responsibilities
- Conduct audits and reviews of provider documentation, coding, billing, and reimbursement practices to assess compliance with applicable laws, regulations, payer requirements, and organizational policies.
- Evaluate the accuracy, completeness, and adequacy of clinical documentation to ensure services billed are supported by the medical record and meet coding, billing, and medical necessity requirements.
- Perform ongoing monitoring activities to identify compliance risks, billing vulnerabilities, coding trends, and opportunities for process improvement.
- Review provider and advanced practice provider documentation for adherence to federal and state regulations, Medicare and Medicaid requirements, commercial payer guidelines, and industry standards.
- Identify potential overpayments, underpayments, coding inaccuracies, documentation deficiencies, and other compliance concerns, and recommend appropriate corrective actions.
- Collaborate with compliance team, providers, advanced practice providers, revenue cycle staff, operational leaders, and other departments to resolve identified issues and improve compliance performance.
- Provide education and training to providers and staff regarding documentation requirements, coding standards, billing regulations, compliance expectations, and best practices.
- Serve as a subject matter resource on provider documentation integrity, coding, billing compliance, reimbursement requirements, and regulatory developments.
- Assist in the development, review, and revision of policies, procedures, and internal controls related to provider documentation, coding, billing, and compliance activities.
- Maintain thorough and accurate audit workpapers, documentation, reports, and records in accordance with compliance and departmental standards.
- Assist in monitoring changes in healthcare laws, regulations, payer guidance, coding requirements, and industry best practices, and assess organizational impact.
- Promote a culture of integrity, ethical conduct, accountability, and regulatory compliance throughout the Mary Free Bed system.
Perform other duties and special projects as assigned by the Compliance Officer.
We’ll embrace all people by:
Treating everyone with dignity and respect.
Opening more doors to opportunity for others to succeed.
Growing talent and people.
Ensuring a welcoming experience for all we serve, regardless of origin, race, religion, disability, sexual orientation or socioeconomic status.
Taking action against discrimination.
Honoring our differences and how we collaborate.
Educating staff, patients and the communities we care for. Restoring hope and freedom, together.
Customer Service Responsibilities
Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.
Responsibilities in Quality Improvement
Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.
Essential Job Qualifications
- Education: Bachelor’s degree or higher in health information management, healthcare administration, nursing or related field.
- Experience: 2-5 years of provider coding and billing experience in professional services.
Experience auditing:
- Evaluation and Management (E/M) services
- CPT coding
- ICD-10-CM diagnosis coding
- HCPCS Level II coding
- Modifier usage
- Medicare and commercial payer requirements
- Documentation requirements supporting billed services
- Extensive knowledge of healthcare compliance policies, programs, practices, standards and related compliance issues
- Advanced knowledge of compliance and auditing principles, theories and concepts
- Auditing, Compliance, Healthcare billing and/or coding certification preferred.
- Knowledge of billing procedures and systems.
- Demonstrated experience and success with customer service principles with a varying group of people
- Possesses organizational, communication and complex problem-solving skills
- Experience with computers and application software
- Works independently and with minimal direction.
- Works efficiently and with flexibility in high-stress and fast-paced situations.
- Participates as a collaborative team member to maximize group effectiveness. Maintaining confidentiality of MFB Health records and systems
Physical Requirements for Essential Job Qualification
Levels:
- None (No specific requirements)
- Occasionally (Less than 1/3)
- Frequently (1/3 to 2/3)
- Majority (More than 2/3)
Remain in a stationary position: Frequently
Traverse or move around work location: Occasionally
Use keyboard: Majority
Operate or use department specific equipment: Occasionally
Ascend/Descend equipment or ladder: None
Position self to accomplish the Essential Functions of the role: Occasionally Receive and communicate information and ideas for understanding: Frequently
Transport, position, and/or exert force: Up to 10 pounds: Occasionally
Up to 25 pounds: None
Up to 50 pounds: None Up to 75 pounds: None
More than 100 pounds: None
Other weight: Up to___ pounds _____ Other: _____
Consistent with the Americans with Disabilities Act (ADA), it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Talent Acquisition team at [email protected].
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.
