Prof Coding & Billing Auditor

Maimonides Medical Center•New York, NY

125d

About The Position

The Prof Coding & Billing Auditor ensures the accuracy of data submitted to governmental and commercial payers and governmental reporting agencies. The role conducts routine and scheduled audits of work completed by Professional Coding Specialists I and II and Professional Billing Specialists I and II. The auditor uses coding and billing expertise to identify issues affecting data integrity and reimbursement, including overpayments and underpayments, and ensures affected encounters are rebilled as corrected claims. The position provides feedback and guidance to coding and billing specialists and, in collaboration with Compliance, to physicians. It identifies training needs, develops annual audit plans related to denials, reviews randomly selected work at statistically significant volumes, and assesses coding, modifiers, sequencing, captured changes, and data-entry accuracy. The auditor coaches staff on compliant appeals, researches and communicates coding and billing rules, may work directly with physicians on code assignments, and creates or maintains relevant policies and procedures. In the manager’s absence, the auditor supervises department activities. The position must comply with organizational and departmental policies and procedures, quality assurance, compliance, privacy and security, safety, environmental, and infection-control measures. The stated pay range is USD $68,000 to $90,000 per year.

Requirements

High school diploma or equivalent.
Completed billing course with certification, such as AAPC Certified Professional Biller (CPB) or American Medical Billing Association Certified Medical Reimbursement Specialist (CRMS).
Successful completion of an AHIMA- and/or AAPC-recognized ICD-10-CM and CPT-4 coding program; CPC, COC, or CCS/CCS-P certification required.
Comprehensive knowledge of ICD-10-CM, HCPCS, and CPT-4 classification systems, medical terminology, anatomy, and physiology.
Demonstrated skill in coding conventions.
At least 5 years of prior professional clinical coding experience.
At least 3 years of experience at the Medical Center in the Professional Outpatient Coding Department or in a comparable coding and billing role, with demonstrated achievement of quality and quantity requirements.
Must pass the Coding Competency Test.
Strong, accurate keyboard skills and successful completion of a basic data-entry skills test.
Experience with encoders and computer-assisted coding (CAC).
Spreadsheet and word-processing experience.
Ability to work with firm deadlines, achieve results, and perform multiple tasks effectively.
Familiarity with navigating billing systems.
Knowledge of third-party billing policies and procedures, including Medicare/Medicaid, Managed Care, No-Fault, and Workers’ Compensation.
Appeal and/or denial management experience.
Ability to use e-mail effectively.
Excellent oral and written communication skills and good interpersonal skills.
English speaking, reading, and writing ability sufficient for the position.

Nice To Haves

One to two years of college.
At least 3 years of billing experience.
Auditing experience.

Responsibilities

Provide guidance to coding and billing specialists to improve accuracy and efficiency.
Review coding and billing work, identify issues affecting data integrity and reimbursement, and ensure affected encounters are rebilled as corrected claims.
Provide feedback to coding and billing specialists and, in collaboration with Compliance, physicians.
Identify training needs and educational opportunities in conjunction with department leadership.
Create an audit plan at least annually to review issues related to denials.
Review randomly selected work products at a statistically significant volume, including E&M, diagnoses, procedures, modifiers, coding sequencing, captured changes, and data-entry accuracy.
Coach coding and billing specialists on proper and compliant appeal preparation and prepare appeals as needed.
Research coding and billing rules and educate specialists; share relevant professional journal articles.
Coach assigned physicians on code assignments, communicate recommended code changes daily, and report progress to department leadership and the Compliance liaison.
Create or maintain policies and procedures for areas of responsibility.
Comply with organizational and departmental policies, quality assurance, compliance, privacy and security, safety, environmental, and infection-control requirements.
Supervise department activities in the manager’s absence.