Pro Fee Auditor

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

About the role

This position is responsible for reviewing medical record documentation to ensure the accuracy of CPT, ICD-10, and HCPCS codes and modifiers for selected claims. The Auditor will follow Northside policy and procedure for annual audit schedules for both physicians and practices, complete professional reports of findings, and deliver results to physicians and leadership.

Responsibilities

• Interprets and reviews medical record documentation to ensure accurate ICD-10, CPT, HCPCS, and modifier assignment based on provider documentation.
• Expertise in auditing using both the 1995 and 1997 E/M CMS Guidelines.
• Provides education to providers, practice staff, and coders as needed based on audit results.
• Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II, and CMS guidelines.
• Applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.
• Maintains an accuracy rate of 90% or above for all Quality Assurance reviews.
• Completes assigned work in a timely manner and maintains departmental production standards.
• Maintains open communication with Auditing Supervisor.
• Assists the Revenue Cycle Support Coordinator in setting prices for services and performing market rate studies.
• Assists Coordinators in Decision Support with projects involving analysis of patient charges and chart documentation to improve clinical benchmarking and revenue cycle activities.
• Uses critical thinking and problem-solving skills to work independently with minimal supervision.

Requirements

• B.S. degree in Nursing, Health Information Management, Healthcare Administration, or Business Administration. Relevant years of work experience (8–10 years) may be substituted for a B.S. degree.
• Must have a coding or nursing credential (RHIA, RHIT, CPC, CCS, RN) or a financial background.
• Minimum of 1 year of hospital and/or physician practice coding experience.
• Demonstrated communication skills and ability to work independently and effectively with various types of personnel.
• Knowledge of Microsoft Office products.
• Advanced knowledge of medical terminology, CPT, ICD-9-CM, and HCPCS coding, Medicare, Medicaid, and commercial insurance procedures.
• Ability to communicate both verbally and in writing with co-workers and physicians, including explaining complicated coding and compliance concepts.
• Knowledge of Medicare and Medicaid policies required.
• High degree of accuracy and attention to detail.
• Ability to work well with minimal guidance.
• Objective and detailed approach to problem-solving.
• Good investigative and organizational skills.
• Extensive experience and knowledge of inpatient and outpatient coding, billing, and documentation requirements in large hospital systems.
• Advanced knowledge of medical records procedures and federal/state laws governing medical records privacy and release of information.
• Skill in exercising initiative, judgment, and decision-making to achieve organizational objectives.
• Ability to maintain confidentiality of sensitive information.

Preferred Qualifications

• Certified Professional Medical Auditor (CPMA).
• Three to five years' experience in a hospital and/or physician practice setting.