Job Title: Coding and Compliance AuditorJob Location: Charlestown, MA 02129Job Duration: 4+ Months (starts in Aug) Responsibilities:
• The Coding & Compliance Auditor performs complex operational and financial audits of provider claims using established work processes and job aides.
• The Auditor also mentors less experienced staff.
• Extensive knowledge of claim processing and policies is required.
• This position also requires a working knowledge of medical terminology and coding skills to evaluate accuracy of charges according to reimbursement policies, and industry standard billing and coding guidelines as adopted. Key Functions/Responsibilities:
• Demonstrates expert knowledge and understanding of benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations as well as industry standards for claim adjudication.
• Performs operational and financial audits of provider claims to identify issues with system configuration, provider contracts, claims operations, provider billing accuracy, and other party liability processes.
• Adjudicates claims following established recovery guidelines and job aides.
• Identifies potential recovery projects and reports findings to management.
• Remains current with claims adjudication processes and internal and external software systems, including Facets, CAD, and Ingenix/Code Manager.
• Achieves department production, quality requirements and individual financial recovery goals.
• Ensures multiple audit projects are completed within designated audit deadlines.
• Participates in special projects and initiatives.
• Assists in developing/revising departmental policies and procedures.
• Attends and participates in team meetings.
• Mentors and coaches less experienced staff and new hires. Qualifications:Education:
- Bachelor’s Degree in Healthcare Administration, business related field or an equivalent.
- Combination of education, training and experience is required.
- Intermediate knowledge of medical terminology, CPT, ICD9, HCPCS coding
Certification or Conditions of Employment:
- CPC or CCS certification a plus. Experience:
- 2 or more years’ experience in a progressive role within healthcare or managed care field required.
- 3 or more years’ experience as a claims analyst required.
- Working knowledge of Facets claim processing system preferred.
- Prior Auditing and/or Medical Record review experience desired.
Working Conditions and Physical Effort:
- Strong oral and written communication skills.
- Ability to interact within all levels of the department.
- A strong working knowledge of Microsoft Office products.
- Detail oriented, excellent proof reading and editing skills.
- Sensitive provider customer service skills.
- Must be able to multi-task, prioritize projects and work well with deadlines.
- Must be able to be flexible and willing to perform all necessary and appropriate duties to ensure the attainment of departmental and organizational goals.
- Regular and reliable attendance is an essential function of the position.
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.
Healthcare Common Procedure Coding Systems