Senior Auditor, Billing Compliance
About the position
Responsibilities
• Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments.
• Analyze source documents and associated billing documentation for coding and billing accuracy.
• Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation.
• Conduct internal Compliance investigations in response to external concerns.
• Identify trends or patterns of questionable coding and billing practices and report issues to Manager.
• Communicate incidental findings identified in audits for potential future investigation.
• Document relevant findings for all audits and investigations conducted.
• Calculate reimbursement impact and statistical error rates based on findings in audits and investigations.
• Facilitate communication of audit and investigational activities between internal/external customers.
• Keep current on topics related to coding, billing, and documentation requirements.
• Work on special projects related to Billing Compliance as assigned.
Requirements
• Bachelor's degree required.
• Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC) required.
• 3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
• Experience with analyzing and/or auditing Revenue Cycle functions, including ICD-10, CPT, and HCPCS coding accuracy.
• Experience with compliance auditing, facility and physician coding/billing practices, and PPS systems of payment preferred.
Nice-to-haves
• Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.
• Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, and practice management.
Benefits
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities
Apply Now
Apply Now
Responsibilities
• Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments.
• Analyze source documents and associated billing documentation for coding and billing accuracy.
• Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation.
• Conduct internal Compliance investigations in response to external concerns.
• Identify trends or patterns of questionable coding and billing practices and report issues to Manager.
• Communicate incidental findings identified in audits for potential future investigation.
• Document relevant findings for all audits and investigations conducted.
• Calculate reimbursement impact and statistical error rates based on findings in audits and investigations.
• Facilitate communication of audit and investigational activities between internal/external customers.
• Keep current on topics related to coding, billing, and documentation requirements.
• Work on special projects related to Billing Compliance as assigned.
Requirements
• Bachelor's degree required.
• Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC) required.
• 3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
• Experience with analyzing and/or auditing Revenue Cycle functions, including ICD-10, CPT, and HCPCS coding accuracy.
• Experience with compliance auditing, facility and physician coding/billing practices, and PPS systems of payment preferred.
Nice-to-haves
• Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.
• Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, and practice management.
Benefits
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities
Apply Now
Apply Now