Pro Fee Auditor

Northside Hospital Inc.•Brookhaven, GA

3d•Onsite

About The Position

This position provides the opportunity to be responsible for reviewing medical record documentation making sure that the CPT, ICD-10 and HCPCS codes and modifiers are correct for the selected claims. The Auditor will follow Northside policy and procedure for annual audit schedules for both physicians and practices. The Auditor is responsible for completing professional reports of their findings and delivering those results to physicians and leadership.

Requirements

B.S. degree in Nursing, Health Information Management, Healthcare Administration, Business Administration. Relevant years of work experience in the range of 8 - 10 years may be substituted for a B.S. degree.
Must have a coding or nursing credential (RHIA, RHIT, CPC, CCS, RN) or a financial background.
Must have minimum of 1 year hospital and/or physician practice coding experience.
Demonstrated communication skills and an ability to work independently and deal effectively with various types of personnel.
Knowledge of Microsoft Office products.

Nice To Haves

Certified Professional Medical Auditor (CPMA).
Three to five years' experience in a hospital and/or physician practice setting.

Responsibilities

Interprets and reviews medical record documentation to make sure the accurate ICD-10, CPT, HCPCS and assigned based on provider documentation.
Expertise in auditing using both the 1995 and 1997 E/M CMS Guidelines
Provides education to providers, practice staff, and coders as needed based on audit results.
Demonstrates knowledge of sequencing diagnoses and procedures as outlined in the Official Coding Guidelines, CPT, HCPCS Level II and CMS guidelines.
Demonstrate expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem solving skills.
Maintains an accuracy rate of 90% or above for all work Quality Assurance reviews.
Complete assigned work in a timely manner and maintain departmental production standards.
Maintain open communication with Auditing Supervisor.
Proficient in public speaking, presentations, and educational activities Advanced knowledge of medical terminology, CPT and ICD-9-CM and HCPCS coding, Medicare, Medicaid and commercial insurance procedures
Ability to communicate both verbally and in writing with co-workers as well as physicians. Demonstrated ability to explain complicated coding and compliance concepts.
Knowledge of Medicare and Medicaid policies required.
Must maintain a professional appearance and demeanor while working with physicians
High degree of accuracy and attention to detail Ability to work well under little guidance
Objective and detailed approach to problem solving
Good investigative and organizational skills
Extensive experience and knowledge of inpatient and outpatient coding, billing and documentation requirements in large hospital systems
Advanced knowledge of medical records procedures and of federal and state laws governing medical records privacy and release of information
Skill in exercising initiative, judgment, and decision-making to achieve organizational objectives Skill in establishing and maintaining effective working relationships with physicians and staff
Ability to maintain confidentiality of sensitive information
Assist the Revenue Cycle Support Coordinator in setting prices for services and performing market rate studies
Assists Coordinators in Decision Support with other projects involving an analysis of patient charges and chart documentation using various clinical and financial systems to improve clinical benchmarking and revenue cycle activities
Critical thinking and problem solving skills are essential along with the ability to work independently, and with minimal supervision. Must be self-motivated and able to use electronic resources