Hospital Billing Compliance Auditor

5+ years

$36.09-$44.11

Limerick Linthicum

10 Nov. 28, 2024

Job Description

Job Type: Full Time Education: B.Sc./M.Sc./B.Pharm/M.Pharm/Life science Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Position: Compliance Auditor
Location: Linthicum, MD (Hybrid: 3 days in-office, 2 days remote)
Compensation: $36.09 - $44.11 per hour (refer to the 2024-2025 UMMS Benefits Guide for details)

About Us

The University of Maryland Medical System (UMMS) is a nationally recognized, 14-hospital system offering a wide range of academic, community, and specialty medical services. UMMS is one of Maryland’s largest employers and was named America’s Best Large Employer in 2021 by Forbes.

Our diverse and collaborative team is dedicated to caring for Maryland residents, advancing medicine, and transforming lives. We prioritize the well-being, growth, and work-life balance of our employees, making UMMS an exceptional place to build your career.

Position Summary

The Compliance Auditor is responsible for ensuring that compliance initiatives are met across all UMMS Member Organizations. This role involves reviewing claims data, medical records, and billing/payment information to ensure adherence to federal and state program guidelines. The auditor will play a key role in implementing the Corporate Compliance and Business Ethics Group (CCBEG) Auditing and Monitoring Plan, providing analysis, reports, and training to support system-wide compliance.

Work Arrangement:

Hybrid model (3 days in-office, 2 days remote)
Training period requires full in-office presence.

Key Responsibilities

Audit and Analysis

Develop and execute audit plans for scheduled and unscheduled compliance audits.
Conduct documentation and coding audits to ensure alignment with CPT standards and CMS guidelines.
Analyze findings to identify trends, problems, or areas for improvement in billing and documentation.
Draft detailed reports on audit findings and provide actionable recommendations to senior leadership.

Compliance Training and Guidance

Develop and deliver training sessions on coding and billing compliance based on audit results.
Track and communicate updates to coding and billing regulations.
Collaborate with departments to resolve compliance investigations and provide actionable guidance.

Collaboration and Reporting

Work with internal teams, including Compliance Officers, Financial Services, Reimbursement, IT, and Quality Management, to ensure accurate claims submissions.
Provide input on management action plans to address deficiencies.
Monitor and report on compliance metrics to UMMS and its Member Organizations.

Qualifications

Education and Certifications

Bachelor’s degree in Business Administration, Hospital Administration, Accounting, Nursing, or related discipline required.
Certifications preferred:
- AAPC Certifications: CPC, COC, CIC, CPMA
- AHIMA Certification: CCS

Experience

Minimum of five years of clinical experience analyzing data and performing reviews (e.g., utilization management, quality assurance, charge capture, coding, billing, and medical necessity).

Skills and Knowledge

Understanding of Medicare and Maryland Medical Assistance program models.
Ability to navigate payer websites and apply regulatory guidelines.
Proficiency in interpreting medical records and assessing clinical documentation for accuracy in diagnostic/procedural coding.
Strong analytical and problem-solving skills, with an ability to identify compliance trends and develop actionable solutions.

Why Join UMMS?

Recognition and Growth: Named one of America’s Best Large Employers by Forbes, UMMS offers a supportive environment for professional development.
Competitive Pay and Benefits: Generous compensation and a comprehensive benefits package tailored to your needs.
Work-Life Balance: Flexible hybrid work model supporting productivity and personal well-being.

Join us and contribute to a mission-driven organization that is advancing healthcare in Maryland and beyond.

Apply now to make an impact in ensuring compliance and delivering exceptional care!

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