1099 Surgery Auditor at Pinnacle Healthcare Consulting LLC

, , United States -

Full Time

Start Date

Immediate

Expiry Date

02 Apr, 26

Salary

0.0

Posted On

02 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Auditing, Surgical Procedures, CPT Coding, ICD-10 Coding, HCPCS Coding, Healthcare Compliance, Analytical Skills, Attention to Detail, Time Management, Organizational Skills, Communication Skills, Electronic Health Records, Medical Billing Software, Risk Management

Industry

Business Consulting and Services

Description

About the Role: The 1099 Surgery Auditor plays a critical role in ensuring the accuracy, compliance, and integrity of surgical billing and documentation processes. This 1099 position involves conducting detailed audits of surgical claims to verify that all procedures are properly coded and supported by medical records, thereby minimizing errors and potential fraud. The auditor will work independently to analyze complex surgical data, identify discrepancies, and provide actionable recommendations to improve billing practices. By maintaining up-to-date knowledge of healthcare regulations and coding standards, the auditor helps safeguard organizational compliance and optimize reimbursement. Ultimately, this role contributes to the financial health of healthcare providers while supporting ethical and transparent surgical billing operations. Minimum Qualifications: * Proven experience in medical auditing, specifically related to surgical procedures and billing. * Strong knowledge of CPT, ICD-10, and HCPCS coding systems relevant to surgery. * Familiarity with healthcare compliance regulations such as HIPAA and Medicare/Medicaid billing requirements. * Excellent analytical skills with attention to detail and accuracy. * Ability to work independently as a 1099 contractor with strong time management and organizational skills. Preferred Qualifications: * Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). * Experience working with electronic health records (EHR) and medical billing software. * Background in healthcare compliance or risk management. * Prior experience auditing surgical claims for insurance companies or healthcare providers. * Strong communication skills for effectively liaising with clinical and administrative staff. Responsibilities: * Review and audit surgical claims and related documentation for accuracy, completeness, and compliance with applicable coding standards and regulations. * Analyze medical records to verify that surgical procedures are properly documented and coded according to current guidelines. * Identify discrepancies, errors, or potential fraud in surgical billing and report findings with detailed explanations and recommendations. * Collaborate with healthcare providers, billing teams, and compliance officers to resolve audit findings and implement corrective actions. * Maintain thorough records of audit activities and prepare comprehensive reports to support internal and external reviews. Skills: The required skills enable the auditor to meticulously review surgical documentation and billing codes to ensure compliance and accuracy, which is essential for preventing costly errors and fraud. Analytical skills are used daily to interpret complex medical records and identify inconsistencies or areas of concern. Knowledge of coding systems and healthcare regulations guides the auditor in applying the correct standards and maintaining compliance. Preferred skills such as certification and experience with EHR systems enhance the auditor's efficiency and credibility when conducting audits and communicating findings. Strong communication and organizational skills support collaboration with various stakeholders and ensure thorough documentation and reporting of audit results.

Responsibilities

The auditor will review and audit surgical claims for accuracy and compliance, analyzing medical records to ensure proper documentation and coding. They will identify discrepancies and collaborate with healthcare providers to resolve audit findings.