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SalaryLocation: Chicago, IL
Hospital: RUSH University Medical Center
Department: Revenue Cycle Revenue Integrit
Work Type: Full Time (Total FTE between 0. 9 and 1. 0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)
Summary:
The Billing Coding Auditor uses advanced knowledge of billing, coding, auditing, documentation requirements, and charge capture to solve complex charging scenarios, provide education and assistance to operational departments, support fellow team members, and develop processes/procedures to ensure accurate and timely capture of all chargeable procedures. The Billing Coding Auditor also monitors interfaces and ancillary software related to charging, and codes, and provides high-level professional support in working advanced code edits as well as auditing charges for service lines with potential missed revenue opportunities. The individual who holds this position exemplifies the Rush mission, vision, and values and acts in accordance with Rush policies and procedures.
- 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
- Responsible for accuracy on all accounts within the assigned Epic Work queues and ancillary software systems.
- 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
- Meets 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
Required Job Qualifications:
- Coding credential or certification from AAPC, AHIMA, or specialty-specific credentialling organization
- 5+ years of Epic HB & PB WQ and Charge entry experience
- Minimum of 10 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
- Ability to handle multiple, changing priorities
- Good organizational skills and ability to work as a team member.
- Some college.
Competencies:
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.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.
