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.
Self-motivated leader with a collaborative mindset, driven to take initiative and build the department’s reputation of quality service. Ability to independently develop strategies, design solutions and establish processes, which contribute to team collaboration and department satisfaction. Responsible for auditing charge processes and procedures throughout the organization to maintain charge integrity in compliance with CMS and other regulatory agencies. This role will participate in the defense audit process, perform hospital and payor audits to ensure compliance with annual audit plan, and aid in identifying lost revenue opportunities or overpayments related to coding or billing issues identified through audits.
PRIMARY DUTIES AND RESPONSIBILITIES
- Responsible for performing coding and charge capture audits and monitoring coding and billing activities.
- Engages with Revenue Integrity Nurse Auditor team to perform defense audits; ensure all charges are documented and captured appropriately and billed accurately in compliance with Northside rules and government regulations.
- Assist in the development of a detailed audit plan in conjunction with Coding and Compliance team and CDM team.
- Ability to assess risk and independently make recommendations for audit plan, improvement activities and metrics to measure progress.
- Ensure audits are completed within established timeframe and in accordance with the standards defined by Northside.
- Prepares a report of findings for each audit and the action plan for correction and/or improvement as needed.
- Assist in developing and administering coding education program(s) that ensure clinical departments and internal RI staff maintain coding and billing competencies and are current with coding requirements and regulations.
- Utilizes available resources and continuing education programs to remain knowledgeable and current with coding and billing compliance regulations. Meets annual requirements to maintain coding credential.
- Ability to independently interact with clinicians and Business Office staff to enhance coding and charging compliance.
- Maintains confidentiality of all findings and materials reviewed.
- Provides customer service routinely in interactions with customers such as coworkers, clinical departments, and Business Office.
- Performs other duties as assigned.
- BS. degree in Nursing, Health Information Management, Healthcare Administration or Business Administration; or Associates Degree with 3 years of hospital charge master experience in lieu of a bachelor’s degree.
- Must have a coding credential (RHIA, RHIT, CCS, COC, CPC) or ability to obtain coding credential within 6 months of hire.
- Demonstrated communication skills and an ability to work independently and deal effectively with various types of personnel.
- Experience in training/educating others.
- Thorough understanding of reimbursement methodologies for all payors.
- Understanding of the function of the Chargemaster as well as revenue, CPT and HCPCS coding.
- Good analytical and communication skills.
- Knowledge of Microsoft Office products.
Preferred:
CPMA (Certified Professional Medical Auditor)
8am-5PM
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