Compliance Medical Oncology Auditor

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you.
Compliance Medical Oncology Auditor
Business unit: U.S. Pharmaceutical Solutions and Services
Location: Remote
Position Summary
We are seeking a Compliance Medical Oncology Auditor to perform internal coding and billing audits and reviews. The audits and reviews provide a layer of protection and compliance of fee for services billing and documentation records to assure appropriateness and accuracy of code assignments in accordance with the Center of Medicare and Medicaid (CMS), Medicare Administrative Contractor (MAC) and various State Regulated guidelines. The ideal candidate will develop resolutions to complex problems that require the frequent use of creativity, uses judgment within defined policies and practices, and anticipates change and directs or redirects efforts.
Key Responsibilities

• Performs coding and billing reviews and audits to ensure that billing and coding audits/reviews are conducted in accordance with Compliance department standard operating procedures.
• Ability to understand and follow department standard operating procedures relating to billing and coding audits and reviews.
• Meets audit/review completion in define time duration to minimize impact to audit or review results.
• Able to conceptualize results of billing and coding audits and reviews to identify patterns, trends and variations in coding, documentation practices, operational workflows and billing practices in adherence of federal payor guidelines.
• Prepare results report of findings and recommendations for improvement for internal review and proper distribution to business leaders and Compliance leadership.
• Collaborates with the education group to ensure findings in reviews and audits are accurate and accessible for education to the network.
• Maintains an up-to-date working knowledge of E&M, CPT, ICD-10 CM Coding Clinics.
• Identify, apply, and validate the use of current federal payor guidelines and industry standard clinical indicators, risk factors and treatment protocols used in clinical validation of payment impacting code assignment.
• Abstracting and performing reviews and audits using medical records to assess the documentation present/absent as it compares to the base code set impacting payment, or a requested change in coding in adherence to Medicare, Medicaid and additional federal payor guidelines.
• Review scope includes validation of the E&M, CPT and ICD-10 CM assigned for Medicare, Medicaid, and other government payors based on provider selection.
• Documenting the results and the corrections to be made in a clear and compelling manner along with accurately and concisely providing the supporting evidence from the medical record and/or references, the knowledge and application of effective reconciliation and rebuttal strategies.
• Maintain a professional standard when providing feedback to managers and other members of leadership.
• Must have experience and knowledge of Medical Oncology and Hematology coding and documentation.

Additional Skills

• Ensures strict confidentiality of patient information.
• Accountable for meeting or exceeding both production and quality expectations.
• Meets or exceeds short-term and long-term goals as established for the department.
• Participates in staff meetings and attends other meetings and seminars as required.
• Experience working in a dynamic environment where plans will be adjusted based on environmental and business drivers.
• Ability to work independently and proactively with a sense of urgency and tact.
• Extremely detail-oriented with the ability to identify and track requirements to work plans.
• Knowledgeable of Microsoft Word, Excel, and PowerPoint

Minimum Requirements

• Requires 6+ years of relevant experience.

Critical Skills

• The ideal candidate will have 4+yrs of auditing experience and at least 2yrs of coding experience.
• Must possess an active CCS-P or CPC.
• Demonstrated knowledge of Medical Terminology and Anatomy & Physiology combined with expertise in federal payor guidelines/ third-party payer reimbursement, coding, and documentation requirements.
• Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint) required.

Must be authorized to work in the US. Sponsorship is not available for this position.
At McKesson, we care about the well-being of the patients and communities we serve, and that starts with caring for our people. That's why we have a Total Rewards package that includes comprehensive benefits to support physical, mental, and financial well-being. Our Total Rewards offerings serve the different needs of our diverse employee population and ensure they are the healthiest versions of themselves. For more information regarding benefits at McKesson, please click here.
As part of Total Rewards, we are proud to offer a competitive compensation package at McKesson. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered.
Our Base Pay Range for this position
$75,200 - $125,300
McKesson is an Equal Opportunity/Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.Qualified applicants will not be disqualified from consideration for employment based upon criminal history.
McKesson is committed to being an Equal Employment Opportunity Employer and offers opportunities to all job seekers including job seekers with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to Disability_Accommodation@McKesson.com. Resumes or CVs submitted to this email box will not be accepted.
Current employees must apply through the internal career site.
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