Clinic Data Audit Specialist

CommonSpirit Health; Sacramento (CA); Sur place; USD 34 000 - 47 000; Plein temps

Résumé du poste

Dignity Health - Methodist Hospital in Sacramento, CA is seeking a Clinic Data Audit Specialist to ensure compliant billing through meticulous chart audits and ICD/CPT coding verification. You will work with finance, accounting, and coding teams to confirm that encounters are correctly documented and charges are valid before submission.

Ideal candidates have at least one year in a medical claims environment, familiarity with Cerner/IDX systems, and a commitment to accuracy and regulatory

Qualifications

• Minimum one year of experience in a medical environment handling insurance claims.
• Strong knowledge of ICD and CPT coding and medical necessity requirements.
• Attention to detail to minimize coding errors and ensure compliant billing.

Responsabilités

• Perform audits to verify documentation accuracy and support appropriate charges.
• Collaborate with finance, accounting, and coding teams to ensure correct claims.
• Update the CDM dictionary and educate providers on proper documentation.
• Identify and resolve charge accuracy issues before releasing charges.
• Verify diagnosis charges and ensure notes are Co-Signed by a Preceptor.
• Review and validate modifiers (GC/GE) as applicable.

Connaissances

Attention to detail

Medical claims experience

Coding knowledge

Formation

High School Graduate General Studies

High School GED General Studies

Outils

Cerner PCA Charge Viewer

IDX systems

Description du poste

Job Summary and Responsibilities

As our Clinic Data Audit Specialist, you will be knowledgeable in billing procedures with a variety of payer sources and in current ICD and CPT coding in a clinic setting. You are responsible for performing all required testing, audits, and verifying the accuracy of documentation to ensure medical necessity for appropriate charges are within the electronic medical record prior to releasing charges. Every day, you will work closely with the finance, accounting, and coding departments to ensure claims are populated with correct/proper coding, based on Medicare and Medi-Cal billing guidelines. You are responsible for updating the CDM dictionary, and educating, instructing, and updating providers regarding the need to accurately document care to support ICD coding and level of billing. You will act as a resource for questions regarding coding/billing and perform other duties as assigned. To be successful in your role, you will meticulously audit and verify documentation accuracy to ensure medical necessity and appropriate charges within the Electronic Medical Record prior to releasing charges. You will demonstrate exceptional expertise in billing procedures, ICD/CPT coding, and regulatory guidelines, proactively collaborating with finance, accounting, and coding departments to ensure claims are correctly populated and educating providers on proper documentation, all to optimize revenue integrity and compliance.

• Demonstrates attention to detail to minimize coding errors, performs compliance and quality audits, and ensures accurate billing


• Print and use the Arrived Patient List to capture all encounters


• Cerner PCA Charge Viewer: Review each Encounter to make sure there is a diagnosis charge and the note is CoSigned by a Preceptor


• Check BP Codes for HPMG Incentive


• View Office Visit Charges (Delete Duplicates)


• Validate Modifiers (GC – w Faculty / GE –w/o Faculty Modifier)


• Job Requirements*Required


• High School Graduate General Studies and One (1) year of experience in a medical environment handling insurance claims or


• High School GED General Studies and One (1) year of experience in a medical environment handling insurance claims.

Preferred

• Experience with IDX systems


• Experience presenting to Providers and Coders on a one-on-one and group base


• Certified Professional Medical Auditor

Where You'll Work

Founded in 1973, Dignity Health - Methodist Hospital is a 158-bed, acute care, nonprofit hospital located in Sacramento, California. Serving over 80,000 patients annually, the hospital offers a full complement of services including a Level II NICU, heart care, cancer care, women’s health, and neurology. Additionally, Methodist Hospital of Sacramento has been recognized as an LGBTQ+ Healthcare Equality Leader by the Human Rights Campaign Foundation and is a Joint Commission-certified Primary Stroke Center.

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Pay Range

$25.00 - $34.33 /hour