Medical Billing Auditor

Job Title: Medical Billing Auditor
Location: Bahria Town Phase 7, Rawalpindi
Employment Type: Full-Time, On-site
Position Summary:

The medical billing auditor is responsible for reviewing, analyzing, and auditing medical billing, coding, and documentation to ensure accuracy, compliance, and optimal reimbursement. This role ensures that claims are submitted according to payer guidelines, coding standards, and organizational policies. The auditor also identifies errors, trends, and opportunities for process improvement within the revenue cycle.

Key Responsibilities:

• Conduct regular audits of medical billing and coding records to verify compliance with CPT, ICD-10, HCPCS, and payer-specific guidelines.
• Review claims before and after submission to ensure accuracy and completeness.
• Identify and document billing errors, compliance issues, and patterns of concern.
• Prepare detailed audit reports and present findings to management, coders, and billing teams.
• Collaborate with providers, coders, and billing staff to correct identified errors and prevent future discrepancies.
• Monitor regulatory changes (CMS, OIG, HIPAA, and payer rules) and ensure billing practices align with the latest compliance requirements.
• Participate in developing and implementing audit plans, training programs, and corrective action plans.
• Support internal and external audits and assist in resolving payer denials related to coding or billing inaccuracies.
• Track audit results and report trends, risks, and recommendations for improvement.
• Maintain confidentiality and compliance with all applicable healthcare regulations and policies.

Qualifications Education:

• Bachelor’s degree in healthcare administration, health information management, or a related field (preferred).
• An associate degree or equivalent experience in medical billing/coding may be considered.

Experience:

• 3+ years of experience in medical billing, coding, or revenue cycle management.
• Prior experience conducting audits or compliance reviews is strongly preferred.

Certifications (preferred or required):

• Certified Professional Coder (CPC, CIC, or COC) – AAPC
• Certified Coding Specialist (CCS) – AHIMA
• Certified Professional Medical Auditor (CPMA) – AAPC (strongly preferred)

Skills:

• In-depth knowledge of ICD-10, CPT, HCPCS, and payer billing requirements.
• Strong analytical and problem-solving abilities.
• Excellent attention to detail and accuracy.
• Proficient in EHR and billing software (e.g., Epic, Cerner, Athenahealth, NextGen, etc.).
• Strong written and verbal communication skills.
• Ability to work independently and handle confidential information with integrity.

Performance Indicators:

• Audit accuracy and completion rates
• Reduction in billing errors and payer denials
• Compliance with internal and external regulations
• Timely reporting and resolution of audit findings

Job Type: Full-time

Work Location: In person