Billing Coding Auditor-23865

Responsibilities

• Use logic-based critical thinking and decision making to accurately assess and trouble-shoot documentation, images, visit records, registration issues, physician orders, attestations, physician signatures, charges, CPT, HCPCS, ICD-10, and modifiers on patient accounts for hospital/facility (HB) and professional (PB) charges in accordance with CMS and AMA guidelines.
• Solve edits related to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits), Procedure to Procedure (PTP edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner.
• Assess the available charges in the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating revenue codes, descriptions, CPT/HCPCS code and pricing for applicable accounts being reviewed.
• Reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits.
• Works with external vendors, interfaced software, and ancillary software to review charge capture opportunities and documentation to identify missed charges and correct accounts.
• Identify trends, analyze to propose and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges.
• Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts.
• Collaborates with operational departments to ensure accurate and complete medical records and charges.
• Mets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager.
• Researches all current and future complex payor requirements for compliant billing, timely payment, and maximum reimbursement.
• Provides input and implements process improvement initiatives recognizing revenue enhancement and charge integrity opportunities.
• Engages in continual education and training in the revenue integrity field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned.

Requirements

• Coding credential or certification from AAPC, AHIMA, or specialty-specific credentialling organization.
• Minimum of 1 year of Epic HB & PB WQ and Charge entry experience.
• Minimum of 5 years of healthcare experience working with billing, charge entry, charge capture, and code auditing with knowledge of CPT, HCPCS, ICD-10 codes and modifiers.
• High School diploma.
• Experience with practice management software.
• Medical terminology, familiarity with technical billing.
• Self-starter, can work independently.
• Good organizational skills and ability to work as a team member.

Qualifications

• Some college.

Skills

• Physical Demands: Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements. Responsibilities

Benefits

Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits). Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush’s anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case.