Billing Coordinator, PB Coding
Northwestern Medicine
Pro Fee Auditor/Educator
Presbyterian Healthcare Services
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $26 - $40 per hour
Job Level
Mid-LevelSenior
Tech Stack
PHP
About the role
- Support Coding and Documentation Quality Assurance (CDQA) team: implement and ensure compliance with enterprise-wide and department coding policies and procedures
- Perform/manage on-site internal audits or reviews to assess compliance and quality monitoring
- Serve as a resource on documentation, coding, billing, and coding compliance questions
- Work on special coding compliance projects; develop and present educational programs and tools
- Audit and train enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers
- Perform medical record and billing reviews of denied and appealed claims; take appropriate action to ensure accurate payment and coordinate review and tracking of appealed claims with payers
- Research and interpret regulatory agency regulations
- Liaison to Information Services, Finance/Patient Financial Services, hospitals, PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and ancillary departments
- Maintain accurate documentation and up-to-date technical knowledge of legal and regulatory information (ICD-9, ICD-10, CPT-4, HCPCS, APC updates)
- Research compliance issues, recommend and implement corrective action plans, identify lost revenue and overpayments
- Assist in creation of the CDQA Annual Audit Work-plan using OIG work plan, Medicare/Medicaid regulations, RAC, and risk assessments
- Conduct training classes and prepare training materials, including ICD-10 education and EPIC EMR documentation education for providers and clinical staff
- Conduct systematic focused internal audits via medical record and charge ticket review and analyze/summarize audit data for management
- Develop new methods and processes to improve coding efficiency and effectiveness
- Investigate customer concerns regarding patient care and billing and ensure coding functions meet quality and performance standards
- Maintain working knowledge of PHS coding and auditing IT applications
- Travel to all PHS/PMG sites as required; working hours may vary based on projects
Requirements
- High school diploma/GED required
- Must have any one of the following coding certifications at time of hire: CCS, CCS-P, CPC-H, or RHIT/RHIA (or achieve one within one year of hire)
- Must possess at least one of the following license/certifications: RHIT, RHIA, CPC, CCS
- Minimum of three (3) years experience in coding and/or auditing required (three to five years experience as a coder noted)
- Audit experience preferred
- Excellent written and verbal communication skills
- Detail and results oriented
- Ability to work independently and make independent decisions
- Medical terminology, ICD-9, ICD-10, CPT-4, HCPCS knowledge required
- Proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations
- Excellent organizational and planning skills; ability to prioritize multiple tasks and perform them accurately and simultaneously
- Proficient computer skills (Microsoft Word, PowerPoint, Excel) and ability to use internet and other research resources
- Ability to articulate complex regulatory information in layman's terms
- Personal presence characterized by honesty, integrity, and ability to inspire and motivate others
- Must be able to travel to all of the PHS/PMG sites (including overnight)
- Must be able to adapt to frequently changing work priorities and schedules
