Claims Solution Professional Auditor

Intermountain Health • Greenville, SC

1d • $28 - $44

About The Position

Our employees whom we call “caregivers,” take pride in the contribution they make to lowering the cost of healthcare and improving the patient billing experience. Our caregivers work together to provide a collaborative, friendly environment and provide quality and individualized service. Our Professional Claims Auditors leverage their professional coding expertise and knowledge of auditing regulations, protocols, and best practices as they audit and monitor the professional documentation and coding practices of physicians, APPs, clinical staff, and coding and billing personnel. They provide mentorship to Claims Solution Specialists and Claims Solution Specialist-Coders, and engage clinic leadership, providers, and other billing colleagues to participate in the continuous improvement efforts focused on increasing the efficiency and accuracy of the professional claims process. Validates charges as entered by clinician or automated process. Assists with new provider (physician and APP) coding setup and training and maintains ongoing auditing and feedback processes for providers and their staff. Assists professional coding consultants and leadership in performing audits and providing analysis, interpretation, and report of claims denials and other payment issues contributing to poor operational performance.

Requirements

• CPC Coding certification through AAPC or equivalent (e.g. CCS-P (Certified Coding Specialist - Physician) through AHIMA or DIP (certified Documentation Improvement Practitioner) thorugh AHIMA)
• Professional coding experience or medical billing experience

Nice To Haves

• CPMA auditor certification, or equivalent
• Advanced coding knowledge (e.g., CCI edits, appeal management)
• Training in continuous improvement theory and application

Responsibilities

• Audits and monitor the professional documentation and coding practices of physicians, APPs, clinical staff, and coding and billing personnel.
• Provide mentorship to Claims Solution Specialists and Claims Solution Specialist-Coders
• Engage clinic leadership, providers, and other billing colleagues to participate in the continuous improvement efforts focused on increasing the efficiency and accuracy of the professional claims process.
• Validates charges as entered by clinician or automated process.
• Assists with new provider (physician and APP) coding setup and training and maintains ongoing auditing and feedback processes for providers and their staff.
• Assists professional coding consultants and leadership in performing audits and providing analysis, interpretation, and report of claims denials and other payment issues contributing to poor operational performance.

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed