Senior Coding Auditor

Montefiore Health System; Village of Tarrytown (NY); Presencial; USD 85 000 - 115 000; Tempo integral

Resumo da oferta

Montefiore Medical Center in New York is seeking a Senior Coding Auditor to perform detailed audits of medical cases, ensuring accuracy of codes, charges, and documentation. You will review current and retro accounts, report outcomes, and help identify process improvements in coding and charging hospital services.

You will guide and support junior auditors, participate in quality assurance, data analysis, workload monitoring and training. 75% chart/coding review; 25% other duties.

Qualificações

• Bachelor’s degree or equivalent in a health-related field, accounting, finance, management or related field with at least 2 years of related experience.
• Proficient with PCs, word processing, spreadsheets, graphs and database software.
• Knowledge of revenue codes CPT/HCPCS, billing and coding edits (CCI, OCE, MUE, LCD/NCD) and billing and reimbursement practices.
• Strong quantitative, analytical and communication skills.
• Understanding of medical records, hospital bills, insurance terms and payment methodologies.
• Familiarity with regulatory requirements (JCAHO, CMS & Medicaid) and current regulations.
• Knowledge of ICD-10-CM, CPT-4 and CMS memos/transmittals; familiarity with UB-04 and itemized statements.
• Clinical experience in an acute care facility preferred.
• Certifications: AHIMA RHIT/RHIA, CCS or CPC-H.

Responsabilidades

• Audits medical cases to ensure codes and charges are accurate and documented properly.
• Review current and retro accounts and report audit outcomes, detailing savings or losses and data processing errors.
• Identify process improvements related to coding and charging hospital services; provide guidance to Coding Auditors; assist with quality assurance, data analysis, workload monitoring and training.

Conhecimentos

Quantitative skills

Analytical skills

Communication skills

Formação académica

Bachelor’s degree in Nursing, health-related field, Accounting, Finance, Management or related field

Ferramentas

Word processing

Spreadsheets

Database software

Descrição da oferta de emprego

The Senior Coding Auditor performs detailed audits of medical cases to ensure accuracy of assigned codes, charges, availability of documented medical records, medical accounts and compares the cases with the itemized bill and overall procedures. The Senior Coding Auditor reviews and audits current and retro accounts, and reports audit outcomes regarding charge errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill. Works cooperatively with the Associate Directors/Director in the identification of process improvement initiatives related to the coding and charging of hospital services. The Senior Coding Auditor provides guidance and support to the Coding Auditors as requested or required. The Senior Coding Auditor also assists with quality assurance reviews, data analysis, workload monitoring and distribution, and training. 75% of time allocated towards Chart/Coding Review, 25% for other duties.

Qualifications:

• Bachelor’s degree (or equivalent) in Nursing, health-related field , Accounting, Finance , Management or related field and a minimum of 2 years of related experience, or an equivalent combination of education and work experience Required
• Work experience with PCs, word processing, spreadsheets, graphs, and database software applications.
• Proficient in payment review systems, hospital information systems, clinical record information systems, insurance terms and payment and some coding methodologies. Knowledge of revenue codes CPT/HCPCS, billing and coding edits (i.e, CCI, OCE, MUE, LCD/NCD) and billing and reimbursement practices
• Strong quantitative, analytical, and communication skills required.
• Understand medical record , hospital bills, insurance terms, payment methodologies and the charge master.
• Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new regulations, policies and procedures.
• Knowledge of coding guidelines, both ICD-10-CM and CPT-4 and understands CMS (formerly HCFA) Memos and Transmittals and all ancillary department functions for the facility.
• Knowledge of hospital clinical and financial IT applications is required.
• Understanding of the charge capture and the charge creation process is required.
• Understanding of the bill compilation and presentation process is required.
• Understanding of UB-04, itemized statement and medical records in addition to the familiarity with all ancillary department functions for the facility.
• Previous clinical experience in an acute care facility is preferred.
• Must have the following certifications:: American Health Information Association (AHIMA); Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); or Certified Procedural Coder, Hospital (CPC-H).

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.