Provider Documentation & Billing Auditor - Limited Duration

Mary Free Bed Rehabilitation Hospital

3d • Remote

About The Position

The Provider Documentation and Billing Auditor conducts independent audits, reviews, and monitoring activities concerning provider documentation, coding, billing, and reimbursement practices across the Mary Free Bed system. The role assesses compliance with organizational policies and procedures, federal and state laws and regulations, payer requirements, and applicable coding and billing standards to help protect the integrity of provider services and revenue cycle operations.

The Auditor evaluates existing processes to identify compliance risks, control gaps, operational inefficiencies, and opportunities for improvement. Using audit findings, data analysis, and collaboration with clinical, operational, and provider leaders, the Auditor recommends ways to strengthen internal controls, improve documentation accuracy, enhance billing compliance, and support appropriate reimbursement. The position identifies, investigates, corrects, and helps prevent documentation and billing issues through monitoring, education, and proactive compliance initiatives. It serves as a subject matter resource for providers, advanced practice providers, leadership, and staff.

This limited-duration position covers a leave of absence and is eligible for remote work within the United States. It reports directly to the Compliance Officer.

Requirements

• Bachelor’s degree or higher in health information management, healthcare administration, nursing, or a related field.
• 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, and 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.
• Knowledge of billing procedures and systems.
• Demonstrated experience and success applying customer service principles with a varied group of people.
• Organizational, communication, and complex problem-solving skills.
• Experience with computers and application software.
• Ability to work independently with minimal direction and efficiently and flexibly in high-stress, fast-paced situations.
• Ability to participate as a collaborative team member to maximize group effectiveness.

Nice To Haves

• Auditing, Compliance, Healthcare Billing, and/or Coding certification preferred.

Responsibilities

• Conduct audits and reviews of provider documentation, coding, billing, and reimbursement practices for compliance with applicable laws, regulations, payer requirements, and organizational policies.
• Evaluate clinical documentation for accuracy, completeness, and adequacy, ensuring billed services are supported by the medical record and meet coding, billing, and medical necessity requirements.
• Perform ongoing monitoring to identify compliance risks, billing vulnerabilities, coding trends, and process-improvement opportunities.
• 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; recommend corrective actions.
• Collaborate with the compliance team, providers, advanced practice providers, revenue cycle staff, operational leaders, and other departments to resolve issues and improve compliance performance.
• Educate and train providers and staff on documentation requirements, coding standards, billing regulations, compliance expectations, and best practices.
• Serve as a subject matter resource on documentation integrity, coding, billing compliance, reimbursement requirements, and regulatory developments.
• Assist in developing, reviewing, and revising 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.
• Monitor changes in healthcare laws, regulations, payer guidance, coding requirements, and industry best practices, and assess their organizational impact.
• Promote 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.
• Demonstrate excellent customer service and behavioral standards; encourage, coach, and monitor the same in team members, promote teamwork and direct communication, and handle confidential information discreetly and sensitively.
• Contribute to quality improvement by identifying problems and seeking solutions; promote patient and family satisfaction where possible and participate in departmental customer-service monitoring and reporting.
• Maintain confidentiality of Mary Free Bed Health records and systems.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level