Compliance Bill Auditor

Job Summary Under direction of Compliance Officer, Bill Auditor is responsible for bill auditing with overall goal of ensuring charges were billed and paid accurately. Bill Auditor examines medical records, billing information, payment histories, medical processes and regulations to identify inaccuracies, compliance issues and inefficiencies. Bill Auditor is responsible for responding to requests from Medicare, government entities and third party auditors and initiating either appeals or paybacks based on relevant regulations and guidelines. Bill Auditor works with other departments to gather information, conduct internal audits set forth in OIG Work Plan and identifies "problem areas" within the facility. Bill Auditor, together with other members of the department, prepares Corrective Action Plans, conducts education and training and monitors for progress toward improved performance and compliance. Other duties include entering information and comments to tracking system and HMS to ensure responses to audit requests are communicated to other departments and occur within required timeframe, monitoring impact of audits on facility's resources and conducting focus audits to identify areas where change to organizational practices, policies or procedures might be needed to enhance organizational efficiencies and effectiveness.

Physical Demands Note:

"Occasionally" = 1% to 33% of the workday; "Frequently" = 34% to 66%; "Continuously" = 67% to 100%. This may also be described as performance once every 3 minutes = "Occasionally"; once every 1 ½ minutes to 3 minutes = "Frequently"; once every 1 ½ minutes to continuous work = "Continuously". 1. Standing/Walking

• Occasional 2. Sitting
• Frequent 3. Bending
• Occasional 4. Climbing/Reaching
• Occasional 5. Push/Pull
• Occasional 6. Handling/Lifting
• Occasional 7. Manual Dexterity a. HANDS
• Simple grasp
• Continuous; Firm grasp
• Occasional; Fine manipulation
• Occasional b. FEET
• Continuous 8.

Speaking/Hearing/Seeing a.

SPEAKING

• Able to communicate verbally with co-workers, patients, and visitors b. HEARING
• Functional with or without correction c. SEEING
• Functional with or without correction Qualifications 1.

Bachelor's Degree. 2. Experience working in a hospital setting with billing auditing. 3. Knowledge and understanding of healthcare laws and regulations, CMS coverage and payment methodologies, coding and billing, and audit practices. 4. Computer skills and applications required for audits and research.