Regulatory Billing Auditor

MaineHealth•Westbrook, ME

12d•Remote

About The Position

The Regulatory Billing Auditor supports compliant charging, billing, and documentation practices across the MaineHealth system by conducting medical audit reviews and analyses of clinical and technical records. Under the direction of the Regulatory Billing Audit Manager, the role evaluates billing and documentation processes, identifies opportunities for improvement, and supports compliance with healthcare regulations and organizational standards. The Auditor develops expertise in regulatory billing, including outpatient and physician practice billing, and partners with Regulatory Billing leadership and Senior Billing Auditors to broaden knowledge across audit activities. The role analyzes findings, prepares reports and executive summaries, and collaborates with leaders and staff on process improvements, education, and ongoing compliance efforts. This is a fully remote position.

Requirements

High school education is required.
Must possess one or more of the following certifications: CPC, COC, RHIT, RHIA, CCS, or CCS-P.
Five or more years of combined experience in coding, billing, documentation improvement, clinical practice, payer claims adjudication, and/or compliance.
Two to three years of experience with medical auditing, research, and chart review.

Nice To Haves

Secondary coursework in medical billing and coding is preferred.
Additional certifications such as CPMA, CHC, or CPCO are preferred.

Responsibilities

Conduct medical audit reviews and analyses of clinical and technical records.
Evaluate billing and documentation processes for compliance with healthcare regulations and organizational standards.
Identify opportunities for improvement in billing and documentation practices.
Analyze audit findings and prepare reports and executive summaries.
Collaborate with leaders and staff to support process improvements, education, and ongoing compliance efforts.
Partner with Regulatory Billing leadership and Senior Billing Auditors to build expertise across a broad range of audit activities.