This position will perform audits to ensure maximum achievable reimbursement and compliance. Review all defense audits with insurance company auditors. Ensures accurate data collection for reporting purposes from various departments. Ensures charging practices and departmental policies are followed. Reviews remittance advices against charges to ensure proper payment is received for services. Refers denials to appropriate departments within the organization for appeals process. Reviews charge Master for accuracy of information. Finalizes department audit summaries and facilitates Monthly Chart Audit Meetings with Nursing and ancillary departments to establish optimal billing methods that meet with billing compliance standards (regulations).
Ensure charging practices and departmental policies are followed. Responsible for working with all departments regarding proper charting as required by insurance companies and audit agencies.
Bachelor’s degree or
10 years of patient revenue audit experience preferred
Knowledge of CPT, ICD-9, CM, HCPCS coding structures
Clinical Experience Plus
Strong computer skills, including Microsoft programs, especially Excel and Access
10+ years’ experience in a professional organization and/or hospital
Strong analytical skills
Strong communication skills, written and oral.
Solid problem solving abilities
Ability to work independently with moderate supervision
Demonstrates efficiency, initiative, and flexibility
Demonstrates the ability to follow instructions well
Generates quality work product in a timely manner
Demonstrates good organizational and multi-tasking skills and is detailed oriented
Preferred Experienced Clinical Licensed Professional
Preferred Experienced Medical Records Coder of Billing