full-time position with CPA Compliance; 37.5 hours per week; Monday - Friday
Provide audit and research support to physicians, non-physician providers, professional fee billing staff, clinic staff, administrators, and other affected personnel on documentation and billing requirements. Using established auditing and research techniques, determine the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties. Work in close collaboration with the Sr. Auditor/Trainers, Leads, Manager and Director to provide input and assist in the development of any applicable training and education content. Assist in the preparation of reports for the Senior Director, Director, and clinical departments regarding the status or results of the reviews. (The documentation audits are conducted as part of the School of Medicine's Billing Quality Assurance Compliance Program.)
Conduct independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
Research and answer billing and documentation questions or problems submitted by faculty, departments, billing staff, and others to ensure compliance with specific payer regulations and School of Medicine / Clinical Practice Association policies and procedures.
Verify and correct, as necessary, the audit work completed by the Auditors.
Review documentation or coding patterns by a provider, division or department that pose a compliance risk and provides input on recommended solutions.
Assist with the development of training sessions for providers, professional fee billing staff and others on a regularly scheduled or ad hoc basis.
Participate in provider feedback sessions along with the Sr. Auditors/Trainers on the results of their medical record documentation reviews and provides input and support as needed.
Support the management team in the preparation and revision of a Compliance Training Manual for routine and special training programs.
Assist in the research and development of medical record documentation standards and requirements related to clinical services billing.
Keep current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-9-CM Coding, and professional fee billing.
Perform other duties as required.
Bachelor's Degree in health care-related or business-related field, or five years of recent, direct experience with third party payer requirements for physicians required. Master's Degree in a health care related discipline may be substituted for up to one year of experience. Medical Terminology and Anatomy & Physiology courses or demonstrated appropriate knowledge.
Minimum of two years of auditing/billing compliance. Additional years of related experience performed as a consultant with a recognized organization may be substituted at the rate of one year consultancy for two years of other experience. Recent experience with Medicare regulations. A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date. A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date.
Detail-oriented with the ability to handle a high volume of multiple tasks and follow through to completion. Able to learn quickly and work independently to address a variety of complex issues. Has flexibility to adjust to the development and refinement of new processes and procedures. CPT and ICD-9 coding, including coding from clinical documentation or auditing the coding of others. Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement. Demonstrated communication, analytical and organizational skills. Must be self-motivated and comfortable working independently, as a team member. Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.
Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems. Five years of experience. Additional coding certifications. Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes. Demonstrated training or teaching experience.
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