Billing Quality Review Auditor at BREG


Billing Quality Review Auditor

  • Job Category: Healthcare Administration
  • Requisition Number: BILLI03572


Are you looking for an exciting opportunity?

We currently have a full-time opening for Billing Quality Review Auditor. This position is a work-from-home opportunity anywhere in the US. If you are looking for a fast paced environment where you can make a difference every day, then this is the opportunity for you! This position is responsible for providing ongoing feedback, training and education to Breg Billing, Field and Sales teams regarding the accuracy and integrity of companies billing operations. S/he is responsible for the chart review for Medicare and other payers as required. S/he will also conduct clinical reviews of medical records or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. Medicare and applicable payer guidelines will be applied in making clinical determinations as to the appropriateness of coverage.

The right person to join our team is…

This position requires confidence, independent action, initiative, a sense of urgency, and the ability to make decisions and take responsibility for them. A well-suited candidate can react and adjust quickly to changing conditions and come up with practical ideas for dealing with them. This is primarily a task-focused job, requiring a somewhat authoritative, directive leadership style that encourages results-driven, task-oriented collaboration.

Your day will be very busy… you will:

  • Conducts pre and post billing reviews to ensure quality standards are met prior to billing.
  • Recommends improvements to Breg’s quality systems to ensure Best in Class practices.
  • Monitors the results of claims audit policies and procedures and reports findings to appropriate leadership.
  • Completes assignments in a manner that meets the quality assurance goal of 100% accuracy.
  • Maintains related files and records in accordance with company and regulatory requirements and practice.
  • Interprets national and state coding and documentation guidelines to ensure consistent and accurate implementation and compliance with external regulations.
  • Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II to conduct audits.

What your background will be:

  • Minimum Associates degree and 3+ years relevant experience to include minimum 2+ years billing and coding experience. Equivalent combination of education and experience will be considered.
  • Knowledge of quality and audit systems.
  • Proficiency in reimbursement principles, medical terminology, payer groups and networks including Medicare, worker’s compensation and private insurance is highly recommended.
  • Detailed knowledge of anatomy, physiology, and medical terminology.
  • Knowledge of national coding and documentation guidelines and regulations.
  • Competence in assigning ICD10, CPT codes and modifiers.
  • Computer proficiency to include web browser/internet search, MS Outlook, MS office to include Excel, Word and PowerPoint. Technical competence includes the ability to learn new software and systems.

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