Physician Billing Auditing Lead

Lurie Children's Hospital • Chicago, IL

5d • Onsite

About The Position

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Requirements

• Minimum of associate degree is required.
• Coding credentials required such as RHIT, RHIA, CPC, CCS, or CCS-P.
• Requires 3-5 years coding work experience and additional auditing experience.
• Demonstrates thorough knowledge of CPT and ICD-10-CM coding.
• Maintains a thorough understanding for medical record practices, standards, regulations, Joint Commission and Illinois Medicaid coding and reporting requirements.
• Demonstrates understanding of medical terminology, anatomy and physiology and coding classification systems and can apply this knowledge in determining appropriate physician coding.
• Demonstrates the ability to communicate effectively with providers, co-workers and managers.
• Demonstrates the ability to work independently and balance multiple priorities.
• Must be able to utilize coding resources (3M, Encoder Pro, NGS (National Government Services), NCCI, CPT Assistant, payer policies).

Nice To Haves

• Experience with pediatric, multi-specialty healthcare organization preferred.
• Previous experience with project management preferred.

Responsibilities

• Maintains audit schedule and process for monthly and quarterly audits.
• Monitors auditor’s productivity by collaborating with the Auditing Manager to meet designated productivity.
• Performs quality review to meet designated quality accuracy as outlined in the Coder/Auditor Quality and Education Policy.
• Reviews work queues daily to ensure encounters not needed for audit are submitted.
• Performs auditing functions as needed.
• Acts in the capacity of liaison to providers, managers and other coding team members.
• Trains new auditors on department policies and procedures.
• Trains new auditors on auditing software and EMR (Epic).
• Reviews auditing process with new coders.
• Resolves questions, issues, and patient disputes with third party payors, billing coordinators, compliance auditors, external billing company and denial management team that pertain to coding.
• Prepares department coding feedback based on trends and issues identified in audits and denials.
• Works with Coders, Coding Manager, Auditors, and Audit Manager to resolve denials, identify trends, and implement process improvements to increase clean claim rate and improve denial recovery rate.
• Collaborates with Auditing Manager to improve Charge Review work queues workflow through various work queues improvement initiatives.
• Collaborates with Auditing Manager regarding content for auditing bi-monthly meeting including preparing education materials, room reservation and other tasks requirements.
• Collaborates with Auditing Manager to perform and complete revenue cycle coding projects
• Develops and maintains division specific coding protocols for auditing purposes
• Assists Auditing Manager with employee time management on a weekly basis including staffing coverage.
• Assigns appropriate ICD-10-CM diagnosis code(s), CPT procedure codes and modifiers using coding conventions, guidelines, and payor specific requirements.
• Abstract and compile data from medical records for appropriate optimal reimbursement
• Works actively with providers and coders to initiate corrections and resolve discrepancies in coding and documentation.
• Works collaboratively with providers to assure accurate and timely submission of claims related to auditing.
• Provides feedback at division meetings around documentation and coding trends identified by audit.
• Submits help desk tickets and system change requests for coding and collaborates with IM for resolution
• Provides regular communication and education to providers and other clinical teams as indicated.
• Performs job junctions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
• Performs other related duties as assigned.

Benefits

• Medical, dental and vision insurance
• Employer paid group term life and disability
• Employer contribution toward Health Savings Account
• Flexible Spending Accounts
• Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
• 403(b) with a 5% employer match
• Supplemental Life, AD&D and Disability
• Critical Illness, Accident and Hospital Indemnity coverage
• Tuition assistance
• Student loan servicing and support
• Adoption benefits
• Backup Childcare and Eldercare
• Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
• Discount on services at Lurie Children’s facilities
• Discount purchasing program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree