Medical Billing Auditor
Crown Point, IN
Finance – Medical Billing Auditor /
Full-Time /
On-site
The Medical Billing Auditor at GuideStar Eldercare will be responsible for reviewing medical billing records and coding practices to ensure compliance with federal and state regulations, payer requirements, and organizational standards. The role involves auditing charges, coding accuracy, documentation to identify discrepancies, rebill claims as necessary, and/or recommend corrective actions. Analyze trends to improve billing accuracy. This position is classified as non-exempt and is eligible for overtime compensation in accordance with applicable labor laws.
Essential Job Functions and Responsibilities:
- Conduct thorough audits of medical billing and coding to ensure accuracy, compliance, and timely submission of claims.
- Review patient records, insurance claims, and billing data to identify discrepancies or errors.
- Verify that billing practices adhere to regulatory standards and payer contracts, with special attention to neurobehavioral health billing guidelines.
- Manage and interpret complex insurance policies, ensuring accurate billing and compliance with payer guidelines.
- Navigating insurance carriers' policies, time limits, and reimbursement structures to enhance claim accuracy and expedite payment processes.
- Collaborate with billing staff and providers to resolve billing issues and improve billing accuracy.
- Prepare detailed audit reports and documentation for management review.
- Assist with internal compliance initiatives and support regulatory audits.
- Stay current with changes in billing regulations, coding standards (CPT, ICD-10), and payer policies.
- Maintain confidentiality of all information.
- Functions performed by the Billing Auditor shall be performed at the Company’s corporate office in Crown Point, IN.
- Punctuality and attendance are important to the successful completion of this position’s job responsibilities.
- Other duties as assigned by the Billing Manager or the Executive Team
Benefits of Working Here:
- Employee's medical premiums are 100% company paid
- $50,000 in basic life and AD&D insurance coverage is provided
- GuideStar 401(k) plan
- 3 weeks (15 days) paid time off plus 7 paid holidays
Required Training and Experience:
- Minimum of three to five (3-5) years of experience in medical billing auditing, with a focus on insurance policy management required.
- Extensive experience navigating insurance carriers' policies, time limits, and reimbursement structures to ensure accurate billing and compliance with payer guidelines.
- Experience in neurobehavioral health services is preferred.
- Proficiency with billing software and electronic health record (EHR) systems.
- Knowledge of Revenue Cycle Management systems.
- Exceptional attention to detail and analytical skills.
- Ability to work independently and manage multiple audits simultaneously.
- Strong communication skills to effectively consult with clinical and administrative staff.
- Knowledgeable in federal and state healthcare billing regulations and compliance standards.
- Proficiency in Microsoft office applications.
- Trustworthy, efficient, and organized.
- Able to pass pre-employment checks, including background checks, motor vehicle record review, credit report, and drug screening.
- Must have reliable transportation between home and office.
All GuideStar employees must be vaccinated against the flu. GuideStar follows all applicable laws; contact humanresources@guidestareldercare.com for more information. Testing for illegal drugs will be administered to all final candidates for whom an offer of employment has been extended.
