Physician Billing Audit Manager

Mount Sinai Medical Center of Miami Beach•Miami Beach, FL

44d•Hybrid

About The Position

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers. Culture of Caring: The Sinai Way Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence. Position Summary: The PB Audit Manager is responsible for leading and managing the auditing functions of Physician Practices across multiple specialties with a focus on Physician & Coder Education. This role ensures coding accuracy, compliance with regulatory guidelines, and optimal reimbursement through proactive audit strategies, education and collaboration with clinical, coding and financial teams

Requirements

Bachelor's Degree in Health Information Management, Healthcare Administration, or related field (preferred).
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential required.
Minimum 5 years of experience in professional fee coding, with at least 2 years in a leadership or auditing role.
Experience providing coder mentorship and physician education in PB coding matters.
Strong knowledge of CPT, ICD-10, HCPCS, and E/M coding guidelines.
Experience with electronic health records (EHRs), coding software, and audit tools.
Excellent analytical, organizational, and communication skills.
Ability to lead and motivate teams in a fast-paced environment.
Proficiency in Microsoft Office Suite and data reporting tools.

Nice To Haves

Certified Professional Medical Auditor (CPMA) preferred.

Responsibilities

Develop and implement a comprehensive auditing program for professional fee coding.
Conduct routine and targeted audits to assess coding accuracy, documentation quality, and compliance with CMS, CPT, ICD-10, and payer-specific guidelines.
Analyze audit findings and identify trends, risks, and opportunities for improvement in documentation and coding accuracy.
Provide mentorship, performance feedback, and ongoing training.
Identify organizational opportunities to partner with Providers, improve coding quality and prevent unnecessary corrective actions
Plan Provider education with Physician Practices as warranted
Collaborate with Compliance and Legal departments to ensure adherence to federal and state regulations.
Support internal and external audit processes, including RAC, MAC, and payer audits.
Maintain documentation of audit results and corrective actions for compliance reporting.
Prepare detailed audit reports and dashboards for leadership, highlighting key metrics and trends.
Roll-out targeted education for improvement based on findings
Work closely with physicians, Physician Practice Administration, Clinical Information Systems, and revenue cycle leadership to resolve coding discrepancies and improve documentation practices.
Serve as a subject matter expert on coding guidelines and reimbursement policies.