The billing compliance auditor is responsible for retrospective audits of patient charts to ensure billing accuracy and compliance. The auditor will determine the sample of charts and will audit the charts for billing and coding compliance for professional service. The auditor will also audit charts for billing compliance for hospital charges. The auditor will be responsible for providing feedback and education to physicians and other staff of audit results and provide education when needed. Reviews and audits documentation in the medical record and charges submitted including CPT and ICD9 information to verify accuracy. Reviews charge information, claims forms and insurances correspondence to determine if coding, billing, claim follow-up, payment receipt, posting activities and credit processing is being performed in an accurate and timely manner and is supported by documentation. Questions and reports inconsistencies when found. Analyzes billing trends to detect areas of non-compliance. Collaborates with Director, Manager of Coding & Compliance, Manager of Corporate to develop yearly audit work plan. Confers with leadership and staff to communicate and educate when deficiencies in documentation and code selection are identified. Meets with department directors or designees to present statistical data on audit findings, provides useful recommendations and documentation tools. Keeps informed on coding and documentation guidelines. Prepares regular reports on audit activities and findings and may report those findings to appropriate committees. Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
What your background should be
Certified professional coder (CPC), certified coding specialist physician (CCS-P) is required. CPMA, CPC-H or CCS-H preferred. 3 to 5 years of coding experience required. Claim processing and/or payment posting experience preferred. Clinical experience in a hospital or physicians office preferred. Demonstrates thorough knowledge of CPT and ICD-9 coding by passing a test. Demonstrates and applies understanding of medical terminology, anatomy and physiology and coding classification systems in determining appropriate physician coding. Demonstrates ability to communicate effectively in both written and oral formats, work independently and balance multiple priorities. Ability to use computer software (i.e.: EPIC, HBOC, IDX, word, excel and powerpoint). May be required to drive to outreach locations. Must have valid drivers license and automobile.
Required Schooling / Training
Bachelor degree
Who is the client company
This is one of the largest pediatric healthcare service provider.
If you are interested in this position, send your resume to apply@kochdavis.com
