Job Summary:
Performs coding and documentation review of records to ensure compliance with company billing policies and procedures, contractual requirements and governmental billing regulations.
Essential Duties and Responsibilities:
Analyze and validate medical records documentation to ensure coding data is compliant with coding guidelines, client-contracted pricing, provider-contracted fees, and per client contractual requirements
Perform audits ranging from moderate to complex
Utilize data analysis and extraction tools to evaluate billing transactions and identify potential billing errors
Identify and research audit findings, presenting concerns and solutions to appropriate leadership
Ensure all information related to findings are appropriately documented according to company policies and procedures
Compile and present audit findings to Operations, Billing, external auditors and others
Identify billing audit findings to the Billing Department and requests corrective actions, such as adjustments to client billing or provider payment
Complete most routine audit functions with minimal supervision
Perform other duties and responsibilities as assigned
Competencies:
Working knowledge of Microsoft Office Suite, with advanced knowledge in Excel
Ability to perform detailed mathematical calculations, understanding mathematical concepts
Ability to manage multiple tasks simultaneously, work independently with minimal supervision and meet stringent deadlines
Attention to detail/excellent follow-up skills
Proactive, self-motivated, and quality-results oriented
Strong organizational, problem-solving, and communication skills
Knowledge of medical billing practices
Knowledge of ICD-9 (International Classification of Disease, Ninth Edition), CPT and HCPC (Healthcare Common Procedure Coding System) coding, medical terminology and CMS (Centers for Medicare & Medicaid Services) guidelines, including NCCI (National Correct Coding Initiative) edits
Excellent interpersonal skills with the ability to work with individuals at all levels of the organization
Education and/or Experience: (includes certificate & licenses)
High School diploma, or equivalent (GED)
0 to 1 year of Medicare billing, medical claims processing, and audit experience
Medical terminology in a medical billing environment is required
Medical Billing Certification preferred
Experience working with IDEA Data Analysis Software preferred
This job description supersedes all prior job descriptions and is intended to describe the general content and essential requirements for the position listed above. It is not to be construed as an exhaustive statement of requirements, duties and responsibilities. Management reserves the right to add or change the duties of this position as required at any time.
QTC Management Inc. is a VEVRAA Federal contractor and an Equal Opportunity Employer. The company has an ongoing commitment to affirmative action and the creation of a workplace free of discrimination, harassment and retaliation. The company recruits, hires, trains, and promotes individuals in all job titles without regard to race, color, creed, religion, ancestry, national origin, age, sex, pregnancy, sexual orientation, gender identity, genetic information, people with disabilities protected under law, and protected veteran status.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
