Medical Auditor - Medical Bill Audit

Department Profile   Tampa General Hospital's Revenue Cycle department delivers comprehensive administrative and clinical services and comprises of four departments - Patient Accounts, Health Information Management, Patient Access, and CDI/Coding. The Patient Accounts Department is a segment of the revenue cycle, responsible for the billing of hospital and professional claims to insurance carriers. The Health Information Management department at Tampa General Hospital is the guard of the electronic health record, collaborating with contributors and customers of health information that include the Medical Staff, Clinical Operations, Information Technology and Finance. While the physicians, nurse and health care team are taking care of patients and loved ones, Health Information Management professionals are the ones taking care of patients' health information- ensuring it is captured, complete, accurate, protected and made available when needed.  Patient Access provides scheduling services to all TGMG locations, radiology locations and other ancillary services. Financial clearance teams ensure scheduled services are authorized for all service lines.  Patient access teams are positioned throughout Tampa General Hospital and in the TGH Emergency Department, TGH Brandon Healthplex, and Rehabilitation locations. The call center is located at the WFLA News Station in downtown Tampa.      Job Summary   Under general supervision and following established policies, procedures and professional guidelines, the Medical Auditor performs medical record reviews to establish the accuracy of patient billing, and to monitor departmental compliance to charge policies. Identifies and recommends corrective actions to departmental Directors when repeated errors or trends occur. Represents the hospital on issues related to billing, documentation and reimbursement with third party payers, patients and hospital personnel. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Hospital.

• Current RN licensure with 3 years recent clinical experience or current LPN licensure with 3 years auditing experience.
• Medical audit experience and credentialed as a Certified Medical Audit Specialist (CMAS) from American Association of Medical Audit Specialists (AAMAS) preferred.
• Completion of the certification program within 2 years of hire is required.