Medical Auditor - Medical Bill Audit

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.