Medical Coding Compliance and Audit Specialist

Orthoillinois; Rockford (IL); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a Medical Coding Compliance and Audit Specialist focused on enhancing coding functions and compliance. The role includes auditing patient accounts, training staff on billing policies, and requires strong expertise in medical coding standards. This full-time position offers an opportunity to contribute to quality improvement measures within OrthoIllinois.

Qualifications

• Minimum of five years of experience in medical claim management.
• Medical coding certification preferred.
• Ability to document compliance issues and prepare training programs.

Responsibilities

• Monitors and audits patient accounts for accurate billing.
• Develops expertise related to Medicare and Medicaid billing.
• Coordinates educational training on billing compliance.

Skills

Advanced understanding of medical terminology

Advanced understanding of commercial insurance

Advanced understanding of Evaluation and Management coding

Advanced understanding of CPT, ICD 10, HCPCS coding requirements

Advanced working knowledge of EHR and insurance portals

Education

High School Diploma or GED

Certified Professional Coder Certification (CPC)

Certified Professional Medical Auditor (CPMA)

Job description

Medical Coding Compliance and Audit Specialist

Job Category: Administration

Requisition Number: MEDIC009510

Apply now

• Full-Time
• Remote
• Hourly Range : $28.78 USD to $38.94 USD

Locations

Showing 1 location

Riverside
5875 E. Riverside Blvd
Rockford, IL 61114, USA

Riverside
5875 E. Riverside Blvd
Rockford, IL 61114, USA

Coordinates review and assessment of OrthoIllinois’ coding and billing functions. Works with the Director of Business Services, Billing Manager, Clinic Managers, Informatics, and Providers to identify and implement systems and methods to improve OrthoIllinois’ coding and billing efficiency and quality of services, and to reduce the practice’s vulnerability to fraud.

Primary Duties and Responsibilities:

· Monitors and audits patient accounts to ensure accurate and compliant billing and documentation

· Develops and maintains expertise related to Medicare and Medicaid billing and medical policies

· Works with Management to research and document medical compliance issues, as well as related laws, policies and procedures of government and private payor health plans related to billing

· Regularly reviews bulletins, newsletters and online portals for insurance policy changes and educates appropriate staff

· Assists Billing Manager and Billing Coordinator to develop and maintain up to date billing policies and procedures. Audits billing staff to ensure compliance to policies and procedures.

· Coordinates with the coding appeals specialist to identify opportunities for improved documentation and provider education based on denial patterns

· Develops and coordinates educational training programs that focus on the billing elements of compliance, and seek to ensure that all appropriate staff and providers are knowledgeable of and comply with the pertinent federal and state standards regarding billing

· Performs audits requested by the Director of Business Services and Billing Manager

· Creates, modifies, and executes reporting to identify billing trends and audit risks

· Runs monthly audit check reports to ensure claim errors are minimized before month end reporting is completed

· Documents all actions taken, to include verbal and written communication

· Service: We align our actions and decision making with the organization’s guiding platform keeping our patients at the center of all we do.

· Change Agent: We support and contribute to positive change in the organization.

· Communication and Interpersonal Relations: We communicate honestly and with compassion to build connections with our patients and each other.

· Effectiveness: We take ownership of work, doing the right thing for our customer and doing it well.

Organizational Culture:

All OrthoIllinois employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making. Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connections.

Education and Experience Requirements:

· High School Diploma or GED required

· Certified Professional Coder Certification (CPC) require; Certified Professional Medical Auditor (CPMA) preferred

· A minimum of five years of experience in medical claim management

· Advanced understanding of medical terminology

· Advanced understanding of commercial insurance, Medicare and Medicaid billing and medical policies

· Advanced understanding of Evaluation and Management (E/M) coding

· Advanced understanding of CPT, ICD 10, HCPCS coding requirements; medical coding certification preferred

· Advanced working knowledge of EHR and insurance portals

Environmental/Working Conditions:

Working environment is in an office/clinic setting.

Physical/Mental Demands:

· Sit, stand, walk, stoop or kneel, crouch or crawl, and climb stairs for long periods of time

· Requires lifting, carrying and/or moving objects in a manner consistent with most office environments (generally, no more than 10 pounds on a frequent basis and 20 pounds on an occasional basis)

· Possess full range of motion in shoulders and arms, including reaching above or below the shoulder

· Finger dexterity; the ability to twist hands/wrists repetitively

· Vision (e.g., depth perception, color vision, strong vision up close), hearing (e.g., high pitch sounds, soft or distant sounds)

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve

Qualifications

Skills

Behaviors

:

Motivations

:

Education

Experience

Licenses & Certifications

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.