Healthcare Compliance Auditor – Medical Billing & Coding

Lexington Health; West Columbia (SC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Day ONE medical, dental and life保险

Flexible spending accounts (FSAs)

403(b) match plan day one

Employer paid life insurance

Supplemental life insurance

Adoption assistance

Disability coverage

Student loan forgiveness

Job summary

Lexington Health in West Columbia, SC seeks a Medical Auditor to analyze hospital and physician records to ensure charges are supported by documentation and billed in accordance with Medicare, Medicaid and third-party rules. You will prepare reports and meet with physicians to review results.

Minimum: Bachelor’s in Business or related field, 3 years’ related experience, CPC/CCS/CPMA certifications; must communicate complex issues clearly and collaborate with APPs, physicians and administrators.

Qualifications

• Strong problem solving skills; ability to articulate orally and in writing an understanding of complex issues and detailed action plans.
• Proficient in Microsoft Office.
• Must communicate with physicians, APPs, senior administrators and department staff.

Responsibilities

• Responsible for conducting audits of hospital and Physician Network records to determine whether services provided to patients are appropriately documented and billed in accordance with Medicare,Medicaid, and third party billing regulations and/or standards.
• Assists the Chief Compliance Officer in investigations relating to erroneous billing and coding of services.
• Works with Health Information Management and Revenue Integrity to conduct coding reviews.
• Drafts formal written reports that summarize medical record findings for review.
• Provides education on coding and billing changes to LMC staff.
• Determines whether medically necessary criteria are met as required by CMS and LCDs.

Education

Bachelor’s Degree in Business or Related Field

Job description

Lexington Health in West Columbia, SC seeks a Medical Auditor to analyze hospital and physician records to ensure charges are supported by documentation and billed in accordance with Medicare, Medicaid and third-party rules. You will prepare reports and meet with physicians to review results.

Minimum: Bachelor’s in Business or related field, 3 years’ related experience, CPC/CCS/CPMA certifications; must communicate complex issues clearly and collaborate with APPs, physicians and administrators.