The Billing Compliance Auditor is responsible for retrospective audits of patient charts to ensure billing accuracy and compliance. The auditor will determine the sample of charts and will audit the charts for billing and coding compliance for professional service. The auditor will also audit charts for billing compliance for hospital charges. The auditor will be responsible for providing feedback and education to physicians and other staff of audit results and provide education when needed.

ESSENTIAL JOB FUNCTIONS:

• Reviews and audits documentation in the medical record and charges submitted including CPT and ICD9 information to verify accuracy.
• Review charge information, claim forms and insurance correspondence to determine if coding, billing, claim follow-up, payment receipt, posting activities and credit processing is being performed in an accurate and timely manner and is supported by documentation.
• Collaborates with Director, Manager of Coding & Compliance, Manager of Corporate to develop yearly audit workplan
• Meets with department directors or designees to present statistical data on audit findings, provides useful recommendations and documentation tools. Prepares regular reports on audit activities and findings and may report those findings to appropriate committees
• Analyzes billing trends to detect areas of non-compliance. Develops Corrective Action Plans and participates in Compliance Investigations as needed.

FTE status: FT-80

Requirements

• Certified Professional Coder (CPC), Certified Coding Specialist - Physician (CCS-P), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) is required.
• CPC-H or CCS-H preferred
• Bachelor's degree preferred
• three to five years of coding experience required
• Claim processing and/or payment posting experience preferred
• Clinical experience in a hospital or physician's office preferred
• Demonstrates thorough knowledge of CPT and ICD-9 coding by passing a test.
• Demonstrates and applies understanding of medical terminology, anatomy and physiology and coding classification systems in determining appropriate physician coding.
• Demonstrates ability to communicate effectively in both written and oral formats, work independently and balance multiple priorities.
• Ability to use computer software (i.e.: EPIC, HBOC, IDX, WORD, EXCEL and PowerPoint).
• May be required to drive to Outreach Locations. Must have valid drivers license and automobile