Job Detail

Overview:
To facilitate Hospital Chart Audit Committee meetings to the extent of presenting results of the insurance audits, concurrent audits and recommendations for remedial actions to be taken. Responsible for pre-audit, auditing all accounts where audits have been ordered and/or completed by insurance companies, external audit agencies, patient requests, business office and concurrent review. Ensure all implant procedures have necessary authorization and invoices/purchase orders for service rendered. Monitor all implant procedures to ensure charges are accurately posted to account, account is billed correctly, and proper reimbursement is received per contractual guidelines. Monitor the entire utilization of implants and product line requiring such implants and trend (volume increase or decrease), Perform analyses to make sure that the changes in regulations, contracts, etc. do not negatively impact the profitability of such product lines. Ensure charging practices and departmental policies are followed. Responsible for working with all departments regarding proper charting as required by insurance companies and audit agencies.

Qualifications:
Medical Terminology

Knowledge of CPT, ICD-9, CM, HCPCS coding structures

Clinical Experience Plus

Strong computer skills, including Microsoft programs, especially Excel and Access

1-3 years experience in a professional organization and/or hospital

Strong analytical skills

Strong communication skills, written and oral.

Solid problem solving abilities

Ability to work independently with moderate supervision

Demonstrates efficiency, initiative, and flexibility

Demonstrates the ability to follow instructions well

Generates quality work product in a timely manner

Demonstrates good organizational and multi-tasking skills and is detailed oriented

Bachelor's Degree preferred

Preferred Experienced Clinical Licensed Professional

Preferred Experienced Medical Records Coder of Billing