Shirley Ryan AbilityLab

Auditor

• Perform audits to assess the quality of documentation, accuracy of charge code assignment and review financial billing statements.
• Assist the compliance officer in assigned projects from internal or external sources.
• Perform assigned Medicaid, Medicare, and other third party payer audits.
• Answer any physician and/or clinic questions and concerns regarding current ICD-10 and CPT guidelines.
• Assist in coding outpatient records as needed.
• Provide coding training and updates for coding staff, physicians and clinics as assigned.
• Assist in coordination of the compilation of data relative to regulatory agencies and the accreditation process.
• Review charge master updates and additions for appropriate current ICD-10 and CPT code assignment.
• Perform all other duties that may be assigned in the best interest of the Shirley Ryan AbilityLab.

Coding Compliance Auditor – Physician Practice

Insurance

• Research and verify financial coverage with third-party payers for planned services prior to patient's scheduled appointment, which includes completing authorization requirements for the patient's specific plan and communicating limitations or denials to patient/family
• Refer cases to outpatient Care Managers or Social Workers when patients are unable to pay for services or services are not covered under a third-party payer.
• Document receipt and forwards appropriate forms (such as a primary care physician referral or a signed agreement to self-pay) to Patient Financial Services.
• Document all financial clearance information in Information System.
• Coordinate Clinic referral and authorization processes including expediting response to referral inquiry, insuring benefits are available, obtaining insurance authorization, assessing clinical information of referral and obtaining social and demographic information to support.
• Screen and respond to requests for general information regarding SRAlab services and programs.
• Identify and verifies patient benefits and initiates the pre-certification process by accessing insurance company, Medicare, and/or Medicaid data bases.
• Identify and implements improvements to enhance efficiency and outcomes and to solve unique or complicated problems.
• Update demographic, insurance, funding and medical information in SRAlab's Information System, as needed.
• Communicate information to the outpatient clinical team or SRAlab inpatient Care Managers as needed.
• Communicate all actual or potential denials to Financial Clearance Supervisor.
• Perform all other duties that may be assigned in the best interest of SRAlab.

Coding Compliance Auditor – Physician Practice

Insurance Coordinator