Job Details

Sunrise,FL - USA

Position Requirements

The Auditor, Revenue Optimization is responsible for conducting audits and reviewing clinical documentation to ensure accurate charge capture and billing in compliance with established billing policies, regulatory requirements, and compliance standards. This role supports the resolution of coding and billing issues, participates in internal and external audits, including payer audits, and contributes to special projects as needed. The Auditor collaborates closely with cross-functional teams to identify opportunities for revenue optimization, improve documentation quality, and support overall revenue cycle integrity.

PRIMARY RESPONSIBILITIES:

• Audit medical records to identify missed charges, incorrect coding, and documentation inconsistencies that impact accurate billing.
• Perform root cause analysis and report findings to identify trends, including over-coding, under-coding, and systemic documentation or billing issues.
• Retrieve missing patient information and required documentation as needed to support accurate audit results.
• Complete coding for unbilled records identified through audit activities.
• Prepare detailed audit reports and representative examples of findings for presentation, education, and process improvement initiatives.
• Support Revenue Cycle Management (RCM) by providing coding guidance, conducting research, and assisting with the development of educational and reference materials.
• Conduct ad hoc audits as needed to support root cause analysis and deliver actionable recommendations for resolution.
• Perform payer audits, including reviewing billed charges against supporting documentation, preparing records for submission to payers, identifying charge discrepancies and CDI opportunities.
• Provide coding expertise and support to cross-functional teams, responding to inquiries and contributing to special projects as assigned.

• CPC® (Certified Professional Coder - AAPC), CCS® (Certified Coding Specialist - AHIMA), CCS-P® (Certified Coding Specialist - Physician-based - AHIMA), or CCA® (Certified Coding Associate - AHIMA) certified.
• Possession of, or ability to obtain, at least one additional relevant coding certification (e.g., CANPC or CPMA) within one (1) year of employment.
• Minimum of three (3) years of professional coding experience, preferably in Anesthesia and/or General Surgery.
• Extensive knowledge of medical billing systems and electronic medical records (EMR).
• Comprehensive understanding of CMS requirements, claims processing, billing and coding guidelines, and the end-to-end Revenue Cycle process.
• Proficient computer skills, including Microsoft 365 applications and advanced Excel skills.

• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities