Sr. Medical Auditor-REMOTE

The US Oncology Network•Norfolk, VA

24d•Onsite

About The Position

The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer! The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit www.usoncology.com.

Requirements

High School diploma/ GED Required
CPC Required
Nine (9) years of billing, coding, and medical records experience required.
Completion of required The US Oncology Network's Reimbursement tutorials as required by the Compliance Department required.
Internal Billing and Coding Integrity Program certification (BCS-M) in Medical Oncology and (BCIP) in Radiation Oncology.
Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits.
Must possess a strong knowledge of current versions of ICD9, CPT4 and HCPCS.

Responsibilities

Performs paper and EMR chart audits for medical oncology physicians/providers in accordance with The US Oncology Network's requirements in order to ensure medical records are commensurate with captured charges and billing.
May use a variety of reports to accomplish tasks, such as AMA guidelines, Medicare LCD's, commercial payor billing guidelines, coding manuals and ASTRO/ACR guidelines.
All new providers will have an E & M audit within 90 days.
Prepares a spreadsheet of findings that details discrepancies and summarizes metrics.
Identifies trends that could be perceived as non-compliance with local and federal regulatory guidelines.
Recommends procedural improvements and training opportunities to management.
Provides written audit report to supervisor for review and approval.
Reviews approved audit findings with physicians and mid level providers to discuss recommendations and improvement opportunities; radiation audit technical findings will be forwarded to appropriate hospital contact.
Recommends and documents audit procedures, standard reports, and metrics in order to provide the appropriate information.
Maintains the confidentiality of medical information contained in each record.
Assists with other audits such as; hospital visits, consultations, and others as assigned.
Assists with The US Oncology Network's audit and compliance or Reimbursement audits such as providing records, audit reports, and standard operating procedure manuals.