Compliance Bill Auditor

Overview

Under direction of the Compliance Officer, the Bill Auditor is responsible for bill auditing with the overall goal of ensuring charges were billed and paid accurately. The role examines medical records, billing information, payment histories, medical processes and regulations to identify inaccuracies, compliance issues and inefficiencies. It also involves responding to requests from Medicare, government entities and third party auditors and initiating appeals or paybacks based on relevant regulations and guidelines.

The Bill Auditor collaborates with other departments to gather information, conduct internal audits per the OIG Work Plan, identify problem areas within the facility, and prepare Corrective Action Plans. The position may include conducting education and training and monitoring progress toward improved performance and compliance. Other duties include entering information and comments into tracking systems and HMS to ensure audit responses are communicated to other departments and completed within required time frames, monitoring the impact of audits on the facility’s resources, and conducting focus audits to identify areas where changes to organizational practices, policies or procedures might enhance efficiency and effectiveness.

• Audit bills and verify that charges are billed and paid accurately.
• Examine medical records, billing information, payment histories, medical processes and regulations to identify inaccuracies and compliance issues.
• Respond to requests from Medicare, government entities and third party auditors; initiate appeals or paybacks as required by regulations and guidelines.
• Collaborate with other departments to gather information and conduct internal audits per the OIG Work Plan.
• Identify problem areas within the facility and prepare Corrective Action Plans.
• Conduct education and training; monitor progress toward improved performance and compliance.
• Enter information and comments into tracking systems and HMS; ensure responses to audit requests are communicated and completed within required time frames.
• Monitor the impact of audits on the facility’s resources; conduct focus audits to identify needed changes to practices, policies or procedures.

• Bachelor’s Degree.
• Experience working in a hospital setting with billing auditing.
• Knowledge and understanding of healthcare laws and regulations, CMS coverage and payment methodologies, coding and billing, and audit practices.
• Computer skills and applications required for audits and research.

• Standing/Walking - Occasional
• Sitting - Frequent
• Bending - Occasional
• Climbing/Reaching - Occasional
• Push/Pull - Occasional
• Handling/Lifting - Occasional
• Manual Dexterity
• HANDS - Simple grasp - Continuous;
  Firm grasp - Occasional;
  Fine manipulation - Occasional
• FEET - Continuous
• Speaking/Hearing/Seeing
• SPEAKING - Able to communicate verbally with co-workers, patients, and visitors
• HEARING - Functional with or without correction
• SEEING - Functional with or without correction