Medical Billing Auditor

Brooklyn, NY / Monsey

$65,000 – $85,000 per year (depending on experience, certifications, and performance)

Our client is seeking a detail-oriented, analytically strong Medical Billing Auditor to join our revenue cycle/finance team. The ideal candidate will audit and review medical billing and coding practices, ensure compliance with payer and regulatory requirements, identify errors and opportunities for improvement, and support risk mitigation and revenue integrity efforts.

Responsibilities:

• Conduct comprehensive audits of submitted claims, billing records, medical documentation, and reimbursement files to verify accuracy, completeness, coding compliance (CPT, ICD-10, HCPCS), and adherence to contractual, regulatory and payer guidelines.
• Review medical provider documentation, compare it to coding, billing and claim submission to ensure alignment and proper reimbursement.
• Identify billing variances, inappropriate or under/over-coding, unbundling, duplicate or missing charges, compliance issues or potential fraud.
• Analyze denied or rejected claims and root causes (e.g., coding errors, documentation gaps, payer edits) and recommend corrective actions.
• Prepare detailed audit reports summarizing findings, trends, dollar impact, recommendations for improvement and presentations to management and stakeholders.
• Collaborate with billing/coding staff, providers, revenue cycle teams, compliance, internal audit or external auditors to implement process improvements, provide training and feedback.
• Stay up to date with changes in federal/state regulations, Medicare/Medicaid requirements, private payer policies, coding guidelines and industry best practices.
• Assist in developing or refining audit methodologies, workflows, checklists, and metrics to improve audit efficiency, accuracy and coverage.
• Maintain high standards of integrity, confidentiality, documentation and record keeping.

Qualifications:

• 1+ years of experience in medical billing, coding, auditing, revenue cycle, or related healthcare finance environment.
• Expertise with coding systems: CPT, ICD-10, HCPCS, and knowledge of modifiers, unbundling, payer edits.
• Strong understanding of medical billing process, claim submission workflow, payer reimbursement, denial management and revenue cycle metrics.
• Excellent analytical skills and attention to detail; ability to review complex documentation and identify issues.
• Strong written and verbal communication skills; ability to present findings, explain issues to non-coding staff, collaborate cross-functionally.
• Proficiency with billing software, electronic health records (EHR) or claims systems, and with MS Office (Excel, Word, PowerPoint).
• Ability to manage multiple audits/projects, meet deadlines, work independently and as part of a team.

Preferred Qualifications:

• Prior auditing experience in a hospital, Medical practice.
• Experience working in New York State or local/regional payer environment (Medicare, Medicaid, commercial).
• Familiarity with compliance frameworks (HIPAA, OIG, Medicare/Medicaid audit standards).