Nicklaus Children's

Billing Compliance Auditor-302144 Description Job Summary Serves as a resource to the NCHS Billing Compliance Program and is responsible for auditing coding and documentation for professional fee and facility services to ensure compliance with federal, state and local regulations, and NCHS policies. Job Specific Duties Conducts coding and documentation audits for professional fee and facility services. Conducts audits for validation of appropriate E/M level, CPT, and ICD-10, Modifier appropriateness according to current AMA and CMS guidelines. Conducts DRG coding and clinical reviews to verify the accuracy of coding, DRG assignment and clinical indicators in accordance with CMS / federal requirements. Conducts quality assurance activities to ensure the accuracy and integrity of billing submitted to Federal and State payers. Analyzes Billing Compliance review outcomes and proactively identifies trends and high-risk areas. Develops appropriate recommendations for Corrective...

Nicklaus Children’s Hospital in Florida seeks a Billing Compliance Auditor to audit coding and documentation for professional and facility services, ensuring compliance with federal, state, and local regulations as well as hospital policies. Responsibilities include auditing CPT/ICD-10, validating E/M levels, DRG reviews, and conducting quality assurance for payer submissions. Strong CMS/Medicaid knowledge and data-mining audit experience are required. #J-18808-Ljbffr