Healthcare Financial Compliance Specialist

2 days ago

Cebu City, Central Visayas, Philippines beBeeMedicalBillingAuditor Full time ₱750,000 - ₱900,000

Job Summary

The role of a Medical Billing Auditor is pivotal in ensuring the accuracy and integrity of medical billing practices.

Responsibilities include conducting thorough audits of medical billing processes, evaluating coding accuracy, claims submission, payment posting, and account management. This involves scrutinizing medical coding, claim submissions, and reimbursement procedures to identify discrepancies, areas for improvement, and potential billing errors.

Key Responsibilities

  1. Audit Medical Billing Practices: Conduct rigorous audits of medical billing processes, including coding accuracy, claims submission, payment posting, and account management.
  2. Review Coding and Documentation: Ensure that medical coding (CPT, ICD-10, HCPCS) is accurate and matches the medical records and services provided by healthcare professionals.
  3. Compliance Monitoring: Verify compliance with federal, state, and payer-specific regulations, including HIPAA, Medicare, Medicaid, and private insurance billing standards.
  4. Identify Errors and Discrepancies: Identify incorrect, incomplete, or inappropriate billing practices, claim denials, or underpayments, and collaborate with the billing team to rectify them.
  5. Claims Analysis: Analyze the outcomes of claims submissions, including denied or rejected claims, and identify trends or patterns that may lead to non-payment or delays.
  6. Provide Feedback and Recommendations: Offer constructive feedback to medical billing staff, healthcare professionals, and administrators on how to improve billing practices, reduce errors, and increase efficiency.
  7. Risk Management: Identify areas of risk for billing fraud, compliance issues, or revenue loss, and recommend corrective actions to mitigate these risks.
  8. Prepare Audit Reports: Generate detailed audit reports summarizing findings, areas for improvement, and actionable recommendations to management and relevant stakeholders.
  9. Educate and Train Staff: Provide training and education to the billing team and healthcare professionals on best billing practices, coding updates, and regulatory changes.
  10. Continuous Improvement: Stay current on billing regulations, payer policies, and medical coding updates, implementing audit processes and tools to enhance auditing efficiency.

Requirements

  • Bachelor's degree in healthcare administration, business, accounting, or a related field (desired).
  • Minimum [X] years of experience in medical billing, coding, or healthcare auditing.
  • Certified Professional Coder (CPC), Certified Medical Auditor (CMA), or equivalent certification (desired).
  • Strong understanding of medical coding (CPT, ICD-10, HCPCS) and medical billing practices.
  • Knowledge of healthcare regulations, including HIPAA, Medicare, Medicaid, and private insurance payer requirements.
  • Experience with Electronic Health Records (EHR) systems and billing software.
  • Excellent attention to detail and analytical skills.
  • Strong communication and report-writing skills.
  • Ability to work independently and collaborate with billing and clinical staff.

Preferred Qualifications

  • Experience auditing billing practices in a medical setting.
  • Certified Coding Specialist (CCS) or Certified Professional Medical Auditor (CPMA) credentials.
  • Familiarity with common billing software such as Epic, Cerner, or Medisoft.

  • Healthcare Documentation Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeQuality Full time ₱250,000 - ₱450,000

    Job TitleQuality Assurance SpecialistThis role involves ensuring the quality and accuracy of documentation in a healthcare setting.ResponsibilitiesAudit patient care documents for completeness, accuracy, and compliance with relevant guidelines.Identify and resolve discrepancies or issues in documentation promptly.Ensure that patient care reports are...

  • Healthcare Insurance Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeHealthcare Full time

    Healthcare Insurance SpecialistWe are seeking a detail-oriented and experienced Healthcare Insurance Specialist to support our insurance verification and authorization processes.Contact insurance providers to verify patient eligibility and coverageAccurately document payer responses in internal systemsFlag missing or unclear information for internal...

  • Senior Financial Compliance Specialist

    1 week ago

    Cebu City, Central Visayas, Philippines beBeeCompliance Full time ₱900,000 - ₱1,200,000

    Accounting Compliance Specialist PositionThe ideal candidate for this role is responsible for managing the preparation, filing, and reporting of financial data and tax-related documents in accordance with local laws and regulations. This position ensures full compliance with government regulatory bodies while also supporting internal financial reporting and...

  • Chief Financial Compliance Officer

    1 week ago

    Cebu City, Central Visayas, Philippines beBeeAccounting Full time ₱900,000 - ₱1,200,000

    Job TitleAccounting and Tax Compliance SpecialistJob DescriptionThe Accounting and Tax Compliance Specialist is a crucial role that oversees the accurate preparation, filing, and reporting of financial data and tax-related documents in accordance with local laws and regulations. This specialist ensures full compliance with government regulatory bodies, while...

  • Comprehensive Healthcare Specialist

    3 days ago

    Cebu City, Central Visayas, Philippines beBeeHealthcare Full time ₱800,000 - ₱1,000,000

    Job OverviewThis is a unique role that combines comprehensive healthcare services with administrative tasks. The ideal candidate will provide medical assistance and support efficient organizational operations through administrative activities.Key Responsibilities:Provide first aid treatment and emergency care to employees for injuries and illnesses.Conduct...

  • Product Specialist

    1 week ago

    Cebu City, Central Visayas, Philippines Getz Healthcare Full time

    Join to apply for the Product Specialist - Surgical Specialty role at Getz Healthcare.The position is primarily responsible for demand creation to achieve territory sales objectives, territory management, relationship building with customers, business development, program implementation, compliance with company policies, procedures, work instructions, and...

  • Healthcare Customer Service Representative

    1 week ago

    Cebu City, Central Visayas, Philippines beBeeCustomerSupport Full time ₱22,000

    Job Title: Healthcare Customer Support Specialist">We are seeking a highly skilled and empathetic individual to join our team as a Healthcare Customer Support Specialist. As a key member of our support team, you will be responsible for delivering exceptional customer service to patients and clients through various communication channels.">Key...

  • Medical Billing Compliance Specialist

    4 days ago

    Cebu City, Central Visayas, Philippines beBeeMedicalBilling Full time ₱300,000 - ₱600,000

    Medical Billing Auditor Job DescriptionThe role of a Medical Billing Auditor is crucial in ensuring the accuracy and compliance of billing practices within a medical practice.Key Responsibilities:Audit Medical Billing Processes: Thoroughly examine medical billing processes, including coding accuracy, claims submission, payment posting, and account...

  • Leading Financial Operations Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeAccounting Full time

    Accounting and Registry SpecialistWe are seeking an experienced Accounting and Registry Specialist to join our team. This is a unique opportunity for a detail-oriented individual to utilize their skills in accounting and registry management.About the Role:This position is responsible for ensuring accurate financial records, maintaining investor records, and...

  • Audit and Compliance Specialist

    1 week ago

    Cebu City, Central Visayas, Philippines beBeeAudit Full time ₱3,000,000 - ₱5,000,000

    Job Opportunity: Audit and Compliance SpecialistAbout the Role:We are seeking a skilled professional to join our team as an Audit and Compliance Specialist. This role involves conducting thorough analyses of financial transactions, identifying areas of opportunity for cost reduction, and implementing strategies to mitigate financial risks.Key...