Professional Billing; PB Auditor – Surgical Specialty

Professional Billing (PB) Auditor – Surgical Specialty

Join to apply for the Professional Billing (PB) Auditor – Surgical Specialty role at Home and Stone Investments

Employment Type: Full-Time

Hours: 30-40 hours per week

Experience

Required:

2+ years PB auditing (surgical focus)

The Professional Billing (PB) Auditor – Surgical Specialty provides ongoing audit support for hospital-based physician billing with a focus on complex surgical services
. This role is responsible for auditing professional fee claims to ensure accurate coding, regulatory compliance, and risk mitigation, while supporting continuous improvement and education for coding staff.

• Perform retrospective and/or concurrent audits of professional billing surgical claims
• Review operative reports and supporting documentation to validate appropriate CPT, HCPCS, and ICD-10-CM code assignment
• Validate modifier usage and bundling in accordance with NCCI edits and payer guidelines
• Identify surgical coding trends, compliance risks, and opportunities for improvement
• Provide clear, educational feedback to professional billing coders related to surgical coding accuracy
• Document audit findings and recommendations in accordance with established audit standards
• Support internal and external audit preparedness related to professional fee surgical services
• Ensure compliance with CMS, AMA, and payer-specific billing regulations

• Minimum 2+ years of professional billing auditing experience with a focus on surgical services
• Strong knowledge of CPT (Surgery section), ICD-10-CM, modifiers, and NCCI edits
• Experience auditing hospital-based physician surgical billing claims
• CPC, CPMA, or equivalent certification preferred
• Strong written and verbal communication skills with the ability to provide constructive audit feedback