Coding and Billing Auditor

This position is responsible for the daily auditing of claims for all payers for adherence to established coding guidelines and optimum reimbursementReports to: Director Revenue IntegrityAudits pre and post payment claims obtained from 3M edits, BIP, referred accounts from HIM at all HPHS facilities, Compliance, Managed Care, Business Office, and Finance to conduct audit of appropriate Coding and Billing practicesDrag Edit DeleteRecognizes the potential for additional Coding and Billing revenues and corrects charges, codes and modifiers as appropriate for unbilled accounts.Drag Edit DeleteResearches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.Drag Edit DeleteInitiates policies and procedures to resolve Coding and charging issues, as needed.Drag Edit DeleteAbstracts pertinent information from medical records to insure the coding of diagnoses and procedures are correct and the appropriate items are charged and recorded on the itemized statement and UB-04.Drag Edit DeleteWorks closely with other departments to resolve Coding and Billing issues and insure accuracy of the information.Drag Edit DeleteProvides review of Coding and Billing performances to ensure compliance with legal and procedural policies and ensures optimal reimbursements are received by HPHS.Drag Edit DeleteServes as a liaison with Health Information Management at all HPHS facilities, Business Office, Managed Care, Utilization Review to assist staff with the clarification of medical necessity and accurate coding.Drag Edit DeleteWorks with compliance consultants to resolve billing/coding issues and assists with education.Drag Edit DeletePerforms quarterly Charge Audits to comply with Life Point SOX audit requirementsMinimum EducationAssociate of Science degree in Health Information Technology or education required to obtain certification held - RequiredDrag Edit DeleteMinimum EducationBachelor of Science degree in Health Information Management - PreferredDrag Edit DeleteRequired SkillsRequires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.Drag Edit DeleteRequired SkillsLicenses: Must hold one of the following credentials: RHIT, RHIA, CCS, CCS-P, CPC, CPC-HDrag Edit DeleteRequired SkillsLicenses:Drag Edit DeleteMinimum Work ExperienceFive (5) years hospital or healthcare experience in a healthcare related field, preferably in hospital Coding and Billing - RequiredEqual opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran