Auditor Medical Billing Specialist

A well established Medical Billing company is seeking an Auditor Medical Billing Specialist is responsible for reviewing, auditing, and monitoring the accuracy and compliance of medical billing activities across all branches.
Key Responsibilities:

Audit Billing Patterns:
Review and identify incorrect billing patterns across the branches.
Ensure billing practices align with company standards and medical aid guidelines.
Post-Submission & Paid Claim Audits:
Conduct thorough reviews of claims after submission to identify potential errors.
Audit claims that have been paid to ensure payments align with the submitted codes and guidelines.
Track and resolve discrepancies related to claim payments and submissions.
Age Analysis & Outstanding Accounts:
Study age analysis reports to monitor and identify outstanding accounts.
Investigate and query any overdue or outstanding claims and ensure timely resolution.
Provide insights on aging accounts to improve billing efficiency.
Code Verification:
Verify that the correct codes are submitted by users/capturers in line with medical aid guidelines.
Identify any inappropriate use of billing codes and work with teams to rectify and improve coding accuracy.
Pre-Submission Error Monitoring:
Proactively monitor claims for potential pre-submission errors to reduce rejections.
Implement safeguards to prevent submission of inaccurate or incomplete claims.
Repeat Error Identification:
Audit the work of users to detect any repeated billing or coding errors.
Identify trends or repeated errors that may signal a need for additional training or process improvement.
Reporting & Feedback:
Generate detailed reports on audit findings and present them to management.
Provide recommendations for process improvements and training to reduce future billing errors.
Collaborate with billing and coding teams to enhance overall accuracy and efficiency.

Qualifications & Skills:

Minimum of a diploma in Medical Billing, Health Information Management, or a related field.
3+ years of experience in medical billing or auditing within the healthcare sector.
Strong understanding of medical billing procedures, coding and medical aid guidelines.

Job Types: Full-time, Permanent
#J-18808-Ljbffr