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ED Billing Auditor

Exceptional Healthcare Inc.
USA
Full-time
Mid · 3+ years experience
Onsite
Discovered 1 months ago
CMDChange HealthcareEPDGoRev

Full Job Posting

We

  • Conduct audits of ED billing and coding for accuracy, completeness, and compliance with CPT, ICD-10, HCPCS, and payer-specific guidelines.
  • Review provider documentation to ensure it supports billed services and appropriate E/M levels.
  • Identify patterns of undercoding, upcoding, bundling errors, or medical necessity issues.
  • Collaborate with coders, billers, and providers to correct errors and provide education/training as needed.
  • Prepare detailed audit reports with findings, trends, and actionable recommendations.
  • Stay up-to-date with regulatory changes from CMS, commercial payers, and industry best practices specific to emergency medicine.
  • Work cross-functionally with compliance, revenue integrity, and quality assurance teams to improve billing workflows and reduce audit risks.
  • Participate in internal and external audits (e.g., RAC, MAC, private payer audits).
  • Help develop internal policies and audit plans related to ED coding and billing practices.
  • Review clinical documentation and provide feedback.
  • 3+ years of experience in medical billing or coding, with a focus on Emergency Department services .
  • Certification required: CPC, CPMA, or CCS-P (AHIMA or AAPC).
  • In-depth knowledge of E/M guidelines, NCCI edits, CMS billing rules , and payer-specific policies.
  • Strong familiarity with coding for ED services, including trauma activations, procedures, and critical care.
  • Experience using EMR and billing systems such as CMD, Change Healthcare, EPD, or GoRev .
  • Excellent analytical and documentation skills.
  • Strong communication skills with the ability to provide constructive feedback to providers and team members.

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