Hospital Billing Compliance Auditor

University of Maryland • Linthicum Heights, MD

394d • $75,067 - $91,749

About The Position

The Hospital Billing Compliance Auditor at the University of Maryland Medical System (UMMS) plays a crucial role in ensuring compliance with federal and state billing regulations across all UMMS Member Organizations. This position involves reviewing claims data, medical records, and billing information to verify that charges and reimbursements are appropriately supported. The auditor contributes significantly to the Corporate Compliance and Business Ethics Group's auditing and monitoring efforts, helping to achieve departmental goals and maintain high standards of compliance.

Requirements

• Bachelor of Science degree in Business Administration, Hospital Administration, Accounting, Nursing, or related discipline.
• Five years of experience in a clinical setting analyzing data and performing reviews related to utilization management, quality assurance, charge capture, coding, billing, and medical necessity.
• Certifications in one or more of the following: AAPC Certifications (CPC, COC, CIC, CPMA) or AHIMA Certification (CCS) preferred.
• Basic understanding of Medicare and Maryland Medical Assistance program models.

Nice To Haves

• Experience with joint commission standards and patient criteria knowledge.
• Ability to read and understand a patient's medical record related to clinical documentation and coding.

Responsibilities

• Research applicable documentation and reimbursement policies to develop an audit plan for UMMS Member Organization audits and investigations.
• Perform documentation and coding audits, reviewing medical records and charges for compliance with CPT coding standards and CMS guidelines.
• Conduct analysis of findings to identify trends and problems in billing and documentation.
• Draft written reports detailing audit findings and recommendations for senior leadership and related business partners.
• Develop and administer coding and billing compliance training based on audit findings.
• Track and report updates to coding and billing regulations.
• Collaborate with various departments to research and resolve compliance investigations.
• Provide input to management for creating action plans to address identified deficiencies.
• Perform activities specified in the Auditing and Monitoring Plan in collaboration with management.
• Plan metrics from Member Organizations and develop reports for feedback.

Benefits

• Competitive salary range of $36.09-$44.11 per hour.
• Comprehensive benefits package as outlined in the 2024-2025 UMMS Benefits Guide.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Educational Services
• Education Level: Bachelor's degree
• Number of Employees: 11-50 employees