{"id":2036358,"url":"https://alion.io/job/fmol-health-code-based-reimbursement-auditor","title":"Code Based Reimbursement Auditor","company":{"id":714842,"name":"FMOL Health","domain":"fmolhs.org","url":"https://alion.io/company/fmolhs","size_band":"1001-5000","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Oracle","truth_index":{"grade":"B","score":84,"open_postings":13,"ghost_share":0,"stale_share":0.846,"repost_share":0,"time_to_fill_p50_days":8,"computed_at":"2026-10-17T05:46:00Z"}},"role":"Finance","role_family":"Finance","seniority":"middle","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Baton Rouge, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":63000,"max_usd":130000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":1579},"experience_years_min":3,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-07T14:37:47Z","employer_posted_date":"2026-10-07","last_verified_at":"2026-10-18T19:28:10Z","board_verified":true,"closed_at":null,"days_open":11,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":11},"description":"The Code-Based Reimbursement Auditor performs audits of Charge Master driven and HIM assigned codes and medical record documentation against the itemized charges and facility assigned on government and non-government accounts and adjusts them for incorrect items and/or services; Assists with billing edit resolution and provides coverage guildelines for billable services. Relies on education, some experience and judgment to accomplish job and works under general supervision. Creativity and some latitude is expected to complete responsibilities of the role.\n Regulatory Compliance & EducationDaily and/or weekly websites are reviewed to include the Federal Register, Medicare and Fiscal Intermediary transmittals, bulletins, and memorandums, including NCD, LCD/LMRP, OCE, and CCI edit management, payment reconciliation, and financial impact analysis.\nWritten communication of current and pending APC and other government program regulations is provided to designated hospital team members.\nBi-yearly training sessions to designated hospital staff and provides education to revenue producing department managers/directors and ancillary department staff is provided on as needed basis.\nAll CMS, Medicare and Medicaid bulletins are reviewed and internal changes are made as needed to keep the facility coding and charge practices compliant with applicable rules and regulations and provides updates to affected departments.\n\nProcess ImprovementMonthly observations and recommendations are made to prevent future billing problems. Develops process improvement initiatives from which government program-related problems can be resolved.\nBill rejections and payment delays due to coding and billing practices as evidenced by CCI edit and LMRP are decreased, increased timeliness and accuracy of federal and state reimbursement, and any other reporting metrics that provide benchmarks to improvements.\nReports are prepared as required by management regarding process improvement recommendations and systemic claim processing issues.\n\nFocused Medical Audit & AnalysisMedical record audits are performed to ensure all services provided are accurately reflected on the itemized statement and all related documents, i.e., UB92.\nFocused retrospective claims/records are reviewed for accuracy. Effectively defends facility charging and coding practices during focused audits.\nCoding and billing problems are identified as they pertain to APCs Reviews claims to ensure correct CPT-4, and HCPCS Level II codes for outpatient accounts.\nData is developed and analysis is created regarding effects on revenues due to requested or mandated changes to the CDM and/or billing practices.\n\nOther Duties as AssignedOther duties as assigned\n\n 3 years experience\nAssociate Degree in Nursing or HIM\n\nProficient in payment review systems, payment methodologies and insurance terms. Ability to synthesize and evaluate data. In-depth knowledge of ICD-9-CM, HCPCS, CPT-4 nomenclature, codes and guidelines and 3M coding software.\nCurrent RHIT or LPN License","description_format":"text","description_chars":3031,"description_truncated":false,"requirements":{"experience_years_min":3,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"associate","optional":false},"security_clearance":false,"languages":[]},"benefits":[],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Care","Urgent & Emergency Care","Hospitals & Health Systems"],"lifecycle":[{"event":"open","at":"2026-10-07T16:10:05Z"}],"visa":[],"liveness":{"score":23,"band":"cold","label":"Long shot","p_open":1,"p_active":0.406,"p_room":0.578,"age_days":9,"expected_fill_days":8,"reasons":["conf:0","stale_co","win:tail"],"computed_at":"2026-10-17T05:46:00Z"},"pay":null,"html_url":"https://alion.io/job/fmol-health-code-based-reimbursement-auditor","json_url":"https://alion.io/job/fmol-health-code-based-reimbursement-auditor.json","meta":{"generated_at":"2026-10-18T19:50:30Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":23904,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-19T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":714842},"rest":"https://alion.io/mcp/rest/get_company?id=714842"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Ffmol-health-code-based-reimbursement-auditor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Ffmol-health-code-based-reimbursement-auditor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Ffmol-health-code-based-reimbursement-auditor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/fmol-health-code-based-reimbursement-auditor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Ffmol-health-code-based-reimbursement-auditor"}]}