- Conducts comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments, as assigned
- Analyzes source documents (including but not limited to, progress notes, operative reports, pathology reports, etc.) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy
- Audits ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation by applying appropriate corporate policy, state/federal regulation, coding rules, commercial payer guidelines, and/or Medicare/Medicaid guidelines (e.g. NCDs, LCDs, Medicare Manuals, and DRG/APC/RBRVS/other relevant Prospective Payment System billing rules)
- Conducts internal Compliance investigations in response to external concerns. These investigations can involve high-risk scenarios that require immediate and extensive review while maintaining a strict level of confidentiality
- Identifies trends or patterns of questionable coding and billing practices for the System and reports issues to Manager. Communicates incidental findings identified in audits for potential future investigation
- Documents relevant findings for all audits and investigations conducted, including pertinent details from interviews, claim audits, control assessment, root cause analysis and corrective action plans
- Calculates reimbursement impact and statistical error rates based on findings in audits and investigations that may later result in larger overpayment calculations. Overpayment calculations may sometimes require data mining and testing skills to ensure report accuracy and using extrapolation methodologies
- Facilitates communication of audit and investigational activities between internal/external customers
- Keeps current on topics related to coding, billing, and documentation requirements, including, but not limited to ICD-10-CM/PCS and CPT/HCPCS annual code changes and Medicare regulatory
- Experience with analyzing and/or auditing Revenue Cycle functions; including, but not limited to, ICD-10, CPT, and HCPCS coding accuracy, Medicare policy requirements and any other operational workflows affecting billing accuracy for hospital or physician claims
- Skilled at medical coding and related research and analysis with the ability to stay up to date on regulatory and coding changes and applying those rule changes into audit and investigation projects
- Must have the ability to interpret a variety of clinical documents and information, CMS policies and procedures, third party payer guidelines and government regulations and effectively communicate technical coding information to a variety of non-coder staff
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Revenue Cycle Auditor - Evanston, United States - The LaSalle Group
Description
Are you a meticulous and experienced Revenue Cycle Auditor looking to join a dynamic team? LaSalle Network has partnered with a premiere healthcare services company as they look to expand their team. As a Revenue Cycle Auditor , y ou will be responsible for investigations received from the revenue cycle department and working a yearly audit plan.
Revenue Cycle Auditor Responsibilities:
Thank you,
Laura Peterson
Associate Unit Manager - Healthcare Revenue Cycle
LaSalle Network
LaSalle Network is an Equal Opportunity Employer m/f/d/v.
LaSalle Network is the leading provider of direct hire and temporary staffing services. For over two decades, LaSalle has helped organizations hire faster and connect top talent with opportunities, from entry-level positions to the C-suite. With units specializing in Accounting and Finance, Administrative, Marketing, Technology, Supply chain, Healthcare Revenue Cycle, Call Center, Human Resources and Executive Search. LaSalle offers staffing and recruiting solutions to companies of all sizes and across all industries. LaSalle Network is the premier staffing and recruiting firm, earning over 100 culture, revenue and industry-based awards from major publications and having its company experts regularly contribute insights on retention strategies, hiring trends and hiring challenges, and more to national news outlets.
