ED Billing Auditor

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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