Medical Coding and Billing Auditor
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POST DATE 8/13/2016
END DATE 10/12/2016
Chickasaw Nation Industries
Oklahoma City, OK
JOB DESCRIPTIONThe Medical Coding and Billing Auditor provides support to the Department of Health and Human Services (DHHS), Indian Health Services (IHS) by auditing the accuracy and consistency of clinical documentation as well as the coding and billing of claims prepared for inpatient and outpatient services.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge / quality of work, supporting financial goals of the company, initiative / motivation, cooperation / relationships, problem analysis / discretion, accomplishing goals through organization, positive oral / written communication skills, leadership abilities, commitment to Affirmative Action, reliability / dependability, flexibility and ownership / accountability of actions taken.
Conducts audits on coding/data entry, provider documentation, billing, charge capture, adjustments/write-off's, aged account follow-up, compliance, and timeliness of preparation and submission.
Using random sampling methodology, performs an independent peer review of documents from check in to reconciliation (check in, registration, coding/data entry, billing, posting, adjustments/write-offs, and reconciliation) to verify accuracy, compliance, and timeliness of preparation and submission.
Conducts aged receivable reviews older than 120 days to verify accuracy, compliance, completeness, and proper submission and follows-up.
Under Medicare Part A, reviews UB-92 and HCFA-1500 professional claims.
Reviews findings and summarizes in reports.
Upon completion of the audit, provides preliminary electronic data tables and narrative documentation of findings and recommendations.
Provides a Coding Department report with an extensive analysis of identified strengths, weaknesses, and suggested improvements, for the coders, within fifteen business days of the audit.
Audits Outpatient elements such as insufficient documentation, that medical record documentation exist for service billed, under or up coded, provider credentials, providers correct use level of E/M code, E/M code bundled into another CPT code, wrong E/M Type assigned, unbundled/bundled codes, lack of specificity (3rd, 4th, 5th, 6th, 7th character ), incorrect modifier assigned etc..
Conducts claim filing audits on private insurance and workers' compensation, Medicare Part A and Part B, institutional claims, professional claims, Medicaid (including State Children's Health Insurance Program if applicable), Beneficiary Medical Program, Non-beneficiary and Veterans Administration.
Conducts a trend analysis for collections, deposits, amounts billed, point of sale rejections, denials, and adjustments by allowance category, age, or payer.
Assists with onsite bi-annual departmental training for patient care providers, nursing, ancillary, coders, billers, and administrative staff in coding/billing documentation requirements/changes, appropriate documentation requirements under ICD-10-CM, ICD-10 PCS, E/M codes, Primary CPT code, Secondary CPT Code, and Primary Diagnosis codes, Secondary Diagnosis codes, and Modifiers for clinical documentation improvement and clinical documentation improvement to enhance revenue recovery.
Responsible for aiding in own self-development by being available and receptive to any training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor's instruction in such a way as to maximize output.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and coworkers. Will report any unsafe conditions and/or practices to the appropriate supervisor and Human Resources. Will immediately correct any unsafe conditions as the best of own ability.
EDUCATION / EXPERIENCE
High school diploma or general education degree (GED) and a minimum of three (3) years relevant experience and/or training, or equivalent combination of education / experience. Experience reviewing claims in an ambulatory and hospital health care organizations. Experience with (CMS 1500) claims, ICD-10-CM, ICD-10-PCS, CPT codes, and HCPCS codes.
CERTIFICATES / LICENSES / REGISTRATION
The reviewers who verify ICD-10-CM, ICD-10-PCS, CPT codes, and HCPCS codes must have one or more of the following current credentials: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist Physician-based (CCS-P), or Certified Professional Coder (CPC). In addition highly preferred individuals with credentials as a Certified Professional Biller- CPB, Certified Professional Medical Auditor- CPMA, or Certified Professional Compliance Officer - CPCO.
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
Knowledge for understanding and applying the official coding clinic guidelines
Knowledge of anatomy / physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines
Working knowledge of medical terminology, general medical ethics and Health Insurance Portability and Accountability Act (HIPAA)
Operational knowledge and understanding of AHIMA Standards of Ethical Coding and compliance practices with ability to educate and train others
Knowledge of a broad range of references such as the ICD-10-CM, ICD-10-PCS, CPT, HCPCS, medical dictionaries, manuals relating to coding textbooks and glossaries
Knowledge of legal and regulatory requirements of medical records
Knowledge of medical records procedures, regulations and principles to carry out a variety of medical records functions such as analysis, coding, ensuring compliance, and compiling data
Knowledge of data collection methods for basic health care, research information and statistical reporting
Knowledge of laws and regulations on the confidentiality of medical records
Solid encoder skills
Skilled proficiency in the use of Microsoft Windows and Office programs (i.e., Word, Excel, Outlook, PowerPoint, etc.)
Excellent customer service skills
Excellent communication skills (verbal, written and presentation)
Detail-oriented with ability to manage multiple projects and priorities
Solid organizational skills relevant to carrying out day-to-day responsibilities
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply commonsense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-one-one and small group situations to customers, clients, and other employees of the organization.