Key Facts

Remote From:

Anywhere

Category: Billing Analyst

Full time

Mid-level (2-5 years)

English

Hard Skills

ICD 503 Cppunit Acute Care Coding Auditing Auditing Medical Necessity Acute Care Coding Procedure Codes Regulatory Compliance Trauma Informed Approaches +7 more

Other Skills

•
Collaboration
•
Communication
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Analytical Skills
•
Training And Development
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Constructive Feedback

Roles & Responsibilities

3+ years of experience in medical billing or coding, with a focus on Emergency Department services
Certification CPC, CPMA, or CCS-P (AHIMA or AAPC)
In-depth knowledge of E/M guidelines, NCCI edits, CMS billing rules, and payer-specific policies
Experience using EMR and billing systems such as CMD, Change Healthcare, EPD, or GoRev

Requirements:

Conduct ED billing and coding audits 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; participate in internal and external audits (RAC, MAC, private payer audits)
Stay up-to-date with regulatory changes from CMS and payers; work cross-functionally with compliance, revenue integrity, and quality assurance teams to improve billing workflows and reduce audit risks; help develop internal policies and audit plans related to ED coding and billing practices

Exceptional Healthcare Inc.

About Exceptional Healthcare Inc.

At Exceptional Healthcare, we are focused on improving the health and well-being of people living in communities with limited healthcare resources. As a premier leader in developing and operating community-based hospitals, our mission is to deliver compassionate, patient-centered emergency care and inpatient hospitalization services using a concierge care service standard. Our vision is simple…it’s in our name. We strive to be the exceptional healthcare choice when life’s emergencies arise. It is our belief that everyone deserves exceptional care, and through Exceptional Community Hospitals, we are making our vision a reality.

Founded: 2018

Company size: 201 - 500

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Job description

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.

Qualifications:

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.