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Billing Compliance Specialist – Audit & Compliance Job in Portland, Maine

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Job Title: Billing Compliance Specialist – Audit & Compliance

Employer:MaineHealth Corporate
Required Certifications:CCS,CCS-P; AAPC-CPC,AHIMA- RHIT,CPMA; HCCA- CHC and/or clinical experience as an RN or LPN,CPC-H
Required Experience:5 to 7 years
Location: Portland 04101, ME, US
Date Posted:7/21/2020

Billing Compliance Specialist – Audit & Compliance

MaineHealth Corporate

Portland, ME

Full Time, Days


Under the direct supervision of the Healthcare Internal Audit Manager, the Senior Healthcare Internal Auditor/Senior Regulatory Billing Auditor is responsible for comprehensive medical audit review and analysis of clinical and technical records to support acceptable and compliant charging, billing and documentation practices at the MaineHealth system.  

Working independently, the Sr. Healthcare Internal Auditor will understand and follow Maine Health’s systematic auditing process to examine and ensure organizational accuracy within the confines of the Federal and State laws, regulations, policies and procedures. Upon audit completion, the candidate will be expected to provide statistical reports of findings and appropriately analyze these findings in the form of an executive summary to the Department or Program Chiefs, Medical Record Services, Patient Accounts and other key senior and executive leaders. 

The auditor will further be expected to present the analysis and recommendations that are used to evaluate compliance with the relevant healthcare regulations and provide technical and educational assistance to various staff to ensure related process improvement.  The Senior Healthcare Internal Auditor may be asked to a mentor Healthcare Internal Auditors within the department.

Five years' auditing experience required

DRG validation experience a plus


  • AHIMA- RHIT, CCS, CCS-P; AAPC-CPC, CPC-H, CPMA; HCCA- CHC and/or clinical experience as an RN or LPN with the expectation of earning a certification within 1 year.
  • 5 years’ experience with broad knowledge of medical terminology, anatomy and physiology, pathophysiology and disease process.
  • In depth knowledge of hospital organizations and medical practices.
  • Knowledge of physician billing practices, CMS billing regulations, CPT coding guidelines from the American Medical Association.
  • Ability to establish and maintain effective working relationships with physicians, subordinates, administrators, supervisors, outside agency personnel, and all levels of hospital personnel in relation to appropriate documentation practices and compliance.
  • Ability to direct the processing, collection, maintenance and analysis of compiled information and the preparation of reports from this data.
  • Ability to maintain confidentiality in the performance of duties.
  • Ability to analyze data and interpret it to others.
  • Ability to work independently and self-directed.

To apply please click here or visit www.careersatmainehealth.org.

Working at MaineHealth:

With a career at any of the MaineHealth member organizations, you’ll be working with healthcare professionals who truly value the people around them – within both the walls of the organization and the neighborhoods that surround it. We are deeply invested in the wellbeing of our communities and employees. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Our care – and the science behind that care – are top rate. Join us and your abilities will be challenged and enhanced as you take your career to another level.


As part of our dedication to operational excellence, we continually invest in technology, innovation and exceptional people in order to deliver on our promise to the people of northern New England. This includes the Shared Health Record initiative, which has changed the way we deliver healthcare within the state. We believe the electronic health record is a necessary tool in the improvement of healthcare delivery and outcomes. Our investment in the technology to support the electronic health record is nothing short of monumental. This means you’ll have the technology necessary to always ensure an optimal patient experience.


MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.


To apply please click here or visit www.careersatmainehealth.org.

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