Clinic Data Audit Specialist

Methodist Hospital Sacramento; Sacramento (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Methodist Hospital Sacramento in Sacramento, CA is seeking a Clinic Data Audit Specialist with expertise in billing procedures and ICD/CPT coding in a clinic setting. You will verify documentation to ensure medical necessity for charges within the EMR before releasing charges.

Work closely with finance, accounting, and coding teams to ensure claims are properly coded and updated, and to educate providers on documentation to support accurate billing and compliance.

Qualifications

• Must have at least 1 year of experience in a medical environment handling insurance claims.
• Demonstrated knowledge of billing procedures and coding guidelines.
• Strong attention to detail to ensure accuracy in documentation and charges.

Responsibilities

• Audit and verify documentation accuracy to ensure medical necessity and correct charges.
• Collaborate with finance, accounting, and coding departments to ensure proper coding.
• Update the CDM dictionary and educate providers on documentation needs for ICD/CPT coding.
• Review encounters in Cerner PCA Charge Viewer to ensure a diagnosis charge and CoSigned documentation by a supervisor.
• Check BP codes for incentives and verify modifiers (GC with faculty / GE without faculty).
• Identify and delete duplicate office visit charges and validate charges.
• Assist in training providers on documentation and coding best practices.

Skills

Medical billing

ICD coding

CPT coding

Auditing

Regulatory compliance

Communication

Education

High School Diploma

GED

Tools

IDX systems

Cerner PCA Charge Viewer

Job description

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 medicalenvironment 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 andCoders 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.

One Community. One Mission. One California