Audit and Billing Compliance Specialist

Responsibilities: The specialist reviews medical records and billing systems to ensure coding accuracy and compliance with federal and state guidelines. They conduct audits, provide education to coding staff, and handle external agency audits and appeals.

Requirements: Requires a bachelor's degree with 3 years of experience or a high school diploma with 7 years of experience in coding/auditing. Must hold a current certification such as CCS, CIC, RHIA, or RHIT.

Key skills: Medical Coding, Billing Compliance, Auditing, CMS Regulations, Inpatient Coding, Outpatient Coding, Regulatory Interpretation, Written Communication, Verbal Presentation, Decision Making, DRG Analysis, Appeal Writing

Keywords: CMS, Medical Coding, Billing Compliance, CCS, CIC, RHIA, RHIT, DRG, OIG Audits, MAC Audits, RAC Audits, MIC Audits, Healthcare Administration, Health Information Management, Revenue Cycle, Clinical Billing