ED Billing Auditor

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April 26

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Exceptional Healthcare Inc.

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Healthcare • Emergency Services • Inpatient Care

Exceptional Healthcare Inc. is a premier healthcare provider focused on delivering comprehensive medical services through its network of community hospitals across multiple states. With a commitment to quality care, it offers 24/7 emergency and inpatient services, advanced cardiac care, and robust onsite labs and radiology capabilities. Exceptional Healthcare is dedicated to serving non-metropolitan areas with state-of-the-art healthcare technologies and a team of highly skilled medical professionals, ensuring that patients receive timely and compassionate treatment for various medical conditions.

201 - 500 employees

Founded 2016

📋 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

🎯 Requirements

• 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