Under general supervision and in accordance with established policies, procedures, and professional guidelines, the Medical Auditor performs detailed medical record reviews to validate the accuracy of charge capture, hos…
Skills: Medical Auditing, Medical Record Review, Hospital Billing, Compliance, Charge Capture
Under general supervision and in accordance with established policies, procedures, and professional guidelines, the Medical Auditor performs detailed medical record reviews to validate the accuracy of charge capture, hos…
Skills: Medical Auditing, Medical Record Review, Billing Compliance, Charge Capture, Clinical Documentation
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Full-time
associate degree, professional certificate
Posted 12d ago
~40 hrs/week
Responsibilities
The Medical Auditor conducts detailed medical record reviews to validate billing accuracy, ensure regulatory compliance, and identify documentation gaps. They also analyze audit trends and provide recommendations to leadership to improve revenue cycle performance.
Requirements
Candidates must hold an Associate's Degree in Nursing or a technical program, along with a valid Florida RN or LPN license. Additionally, professional certification as a CMAS or CPMA and at least three years of relevant clinical or auditing experience are required.
Full job description
Under general supervision and in accordance with established policies, procedures, and professional guidelines, the Medical Auditor performs detailed medical record reviews to validate the accuracy of charge capture, hospital billing and ensure compliance with departmental charge policies and regulatory requirements. This role identifies billing discrepancies, documentation gaps, and compliance trends, and recommends corrective actions to departmental leadership when recurring issues are identified. The Medical Auditor represents Tampa General Hospital in matters related to billing, documentation, and reimbursement with third-party payers, patients, and hospital personnel, while performing all duties in alignment with the mission, vision, and values of Tampa General Hospital.
Essential Functions:
Conducts comprehensive medical record audits to validate accuracy of hospital billing and compliance with departmental charge policies.
Reviews clinical documentation to ensure services billed are supported, complete, and compliant with regulatory and payer requirements.
Identifies billing errors, documentation deficiencies, and compliance risks, and reports findings clearly and accurately.
Analyzes audit results to identify trends or recurring issues and recommends corrective actions to departmental leadership.
Represents the hospital in discussions related to billing, documentation, and reimbursement with third-party payers, patients, and hospital staff.
Maintains detailed audit documentation in accordance with generally accepted audit practices and departmental standards.
Stays current with changes in billing regulations, audit standards, and reimbursement guidelines impacting hospital operations.
Participates in departmental and organizational performance improvement initiatives related to billing accuracy and compliance.
Supports education and orientation efforts by providing audit-related guidance to clinical and revenue cycle staff as assigned. Performs all duties in a manner that promotes professionalism, teamwork, customer service, and adherence to Tampa General Hospital’s mission and values.
Associate's Degree in Nursing or Technical Program Licensed Nursing Assistance required.
Registered Nurse or FL Practical Nurse licensure through the Florida Department of Health required.
Certified Medicaid Audit Specialist (CMAS) from American Association of Medical Audit Specialists (AAMAS) or Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders (AAPC) required.
Florida RN with 3 years recent clinical experience or LPN with 3 years auditing experience.
Medical audit experience required.
Related keywords
Medical AuditorMedical Bill AuditCharge CaptureHospital BillingComplianceRegulatory RequirementsClinical DocumentationReimbursementCMASCPMAAAMASAAPCRevenue CyclePerformance ImprovementNursingAuditing
Tampa General is a private not-for-profit hospital and one of the most comprehensive medical facilities in West Central Florida serving a dozen counties with a population in excess of 4 million. As one of the largest hospitals in Florida, Tampa General is licensed for 982 beds, and with over 15,000 team members, is one of the region’s largest employers.
Consistently recognized for world-class care, Tampa General Hospital is ranked as the #1 hospital in Tampa Bay by U.S. News & World Report for 2024-25 and is nationally ranked as among the top 50 hospitals in the nation in eight specialties. Additionally, Tampa General was ranked as “high performing,” or among the top 10% of hospitals in the nation, in five more specialties along with 12 procedures and conditions.
TGH partners with the USF Health Morsani College of Medicine to pioneer breakthrough treatments, conduct game-changing clinical research and train the next generation of health care professionals. TGH is the region's only academic health system, having been affiliated with the USF Health Morsani College of Medicine since the school was created in the early 1970s.
TGH is the area’s only Level I trauma center and one of two ABA-verified Adult & Pediatric burn centers in Florida. With five medical helicopters, we are able to transport critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. The hospital is home to the leading organ transplant center in the country, having performed more than 14,000 adult solid organ transplants, including the state’s first successful heart transplant in 1985. Tampa General Hospital is committed to serving all residents of West Central Florida. We provide comprehensive health services, ranging from wellness and primary care to the most complex specialty care and post-acute services.
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Companies currently hiring include Tampa General Hospital, University of South Florida - School of Social Work, Quest Diagnostics, UnitedHealth Group, Holland & Knight LLP, among others. Browse the listings above to see every active employer.
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