at NorthShore University Health System in Evanston, Illinois, United States
Job Description
Senior Auditor, Billing Compliance
Position Highlights:
Position: Senior Auditor, Billing Compliance
Location: Hybrid (Evanston, IL and remote)
Full Time/Part Time: Full Time
Hours: Monday-Friday, 8:00am-4:30pm
Travel: travel to other locations in the health system may be required
What you will do:
Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments, as assigned.
Analyze source documents (including but not limited to, progress notes, operative reports, pathology reports, etc) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy.
Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation by applying appropriate corporate policy, state/federal regulation, coding rules, commercial payer guidelines, and/or Medicare/Medicaid guidelines (e.g. NCDs, LCDs, Medicare Manuals, and DRG/APC/RBRVS/other relevant Prospective Payment System billing rules).
Conduct internal Compliance investigations in response to external concerns. These investigations can involve high-risk scenarios that require immediate and extensive review while maintaining a strict level of confidentiality.
Identify trends or patterns of questionable coding and billing practices for the System and reports issues to Manager.
Communicate incidental findings identified in audits for potential future investigation.
Document relevant findings for all audits and investigations conducted, including pertinent details from interviews, claim audits, control assessment, root cause analysis, and corrective action plans.
Calculate reimbursement impact and statistical error rates based on findings in audits and investigations that may later result in larger overpayment calculations. Overpayment calculations may sometimes require data mining and testing skills to ensure report accuracy and using extrapolation methodologies.
Facilitate communication of audit and investigational activities between internal/external customers.
Keep current on topics related to coding, billing, and documentation requirements, including, but not limited to ICD-10-CM/PCS and CPT/HCPCS annual code changes and Medicare regulatory updates.
Work on special projects related to Billing Compliance as assigned by Manager
What you will need:
Education: Bachelor's degree, required
Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC), required.
Experience:
3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience
Experience with analyzing and/or auditing Revenue Cycle functions; including, but not limited to, ICD-10, CPT, and HCPCS coding accuracy, Medicare policy requirements, and any other operational workflows affecting billing accuracy for hospital or physician claims.
Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.
Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, medical office or patient accounts, rehabilitation, clinical trials coding/documentation requirements, home health/hospice, practice management and physician revenue cycle and strategy consulting is a plus.
Unique or Preferred Skills:
Skilled at medical coding and related research & analysis with the ability to stay up to date on regulatory and coding changes and applying those rule changes into audit and investigation projects.
Must have the ability to interpret a variety of clinical documents and information, CMS policies and procedures, third party payer guidelines and government regulations and effectively communicate technical coding information to a variety of non-coder staff.
Benefits:
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300... For full info follow application link.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
