Job Description

Position Overview

The Internal Billing Auditor is responsible for reviewing all billing and documentation before claims are submitted to ensure accuracy, compliance, and integrity across the organization. This role monitors for billing errors, reviews clinician notes, checks coding accuracy, and ensures Medicaid and insurance requirements are met. The position helps reduce denials, supports clean claim submissions, and strengthens the overall revenue cycle.

Key ResponsibilitiesBilling Review & Audit

Conduct internal audits of claims prior to submission. Confirm accuracy of CPT codes, modifiers, units, and ICD-10 diagnosis codes. Verify that documentation supports all billed services. Ensure time-based services and signatures meet Medicaid standards. Review denied claims, identify errors, and recommend corrections.

Compliance & Quality Assurance

Ensure adherence to Medicaid, Medicare, HIPAA, and state regulations. Identify potential fraud, waste, and abuse risks. Maintain organized audit records and logs of findings. Assist leadership during internal and external compliance reviews.

Support & Process Improvement

Provide feedback and education to clinicians regarding documentation requirements. Develop audit checklists and workflow improvements. Track recurring issues and recommend corrective actions. Collaborate with the billing team to enhance claim accuracy and efficiency.

Reporting & Communication

Prepare weekly or monthly audit summaries. Communicate errors and needed corrections professionally. Track patterns, trends, and issues that impact billing accuracy.

Required Skills & Qualifications

2-3 years of medical billing and coding experience

(behavioral health strongly preferred)

Hands-on experience auditing claims

for accuracy, compliance, and documentation support

Experience working with Medicaid, Medicare, and commercial insurance plans

Prior experience reviewing clinical documentation

to ensure it meets payer standards

Experience with reimbursement processes, denials, and appeals

Familiarity with CPT, HCPCS, and ICD-10. Extremely detail-oriented and organized. Ability to work independently and confidentially. Strong analytical and problem-solving abilities. Excellent communication skills. Experience with EHR systems (KIPU, CollabMD, Availity) is a plus.

Licenses & Certifications (Preferred):

CPC, CPB, or CCS (highly preferred) HIPAA certification (required upon hire) CRCR, CMRS, or other billing/compliance certification (preferred) Behavioral health billing certification (a plus) Medical terminology certification (a plus)
Pay: $36,000.00 - $40,000.00 per year

Work Location: In person