The Outpatient Coding auditor will be responsible for validating coding based on various Fee Schedules, CMS and Correct Coding guidelines. Generate an audit utilizing Excel and formulating explanation of benefits that correlate with coding determinations. For claims that do not fall under a set fee schedule, a negotiated rate must be agreed upon between the auditor and provider based on guidelines provided by various insurance company policies. Open communication and accurate documentation must be maintained in order to adhere to strict processing deadlines.
Will assist in the evaluation of medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. This individual will also provide guidance and training on medical coding to physicians and staff.
Develop and use analytical tools to regularly review and confirm appropriate usage of the CDM for clients. Provide appropriate follow-up with clients. Reviews Medicare intermediary and other third-party payor bulletins to keep current on billing requirements, and communicates information to all applicable staff and clients. Participate in initiating, developing and establishing facility specific and regional models for financial analyses as it relates to pricing change recommendations to a client’s charge master.
Provide education and training for client coding staff
- Minimum of two years’ experience of coding within a Healthcare Organization or consulting group for outpatient and/or physician based services
- Evidence of audit experience and written reports
- Supervisory and or mentoring experience preferred
- Ability to meet deadlines and work under pressure
- Evidence of good working relationships within a team
- Excellent communication skills
- Managing people, leadership and motivation and to support others in overcoming barriers to understanding
- Ability to work independently or as part of a team
- Methodical, logical and calm
- Approachable, confident, assertive and hard working
- Problem solving skills Analytical and organized and an ability to interpret complex information and to use own judgement in finalizing reports
- Numeracy and accuracy
- Expertise in the use of MicroSoft Office Suite, particularly MS Word, MS Excel, MSPowerPoint, and Visio
- Experience of presenting highly complex information to audiences with varied levels of understanding
- Experience in leading training programs and the development of focused training materials for various levels of staff including coders, physicians, and clinicians
- Networking: -being able to work within the Organization and with other non-organization with credibility
- Must have knowledge of third party billing procedures across a variety of payer systems and have specific expertise in CPT, ICD-9/ ICD-10 and HCPCS coding for a physician group.
- Must have a working knowledge of Evaluation and Management (E&M) coding and can conduct chart reviews using the current E&M Guidelines
Preferred Experience/Specialized Skills/Certification:
- Charge Master and Revenue Integrity experience in Hospital/Physician Practice Operations
- CDM Review experience
- Two years consulting experience
- Experience managing system wide projects
- Experience managing consulting projects
- Epic or Cerner EMR experience highly preferred
- Previous healthcare financial management or healthcare operations background, and/or clinical experience highly desirable
- Staff or client education and training experience
- PMP Certification
- CPMA coding certifications
- Bachelor of Science, Health Administration/Billing/Coding
- Preferred: Bachelor of Science, Health Informatics and Health Information Management (HIHIM)
- Required: CPC or CCA certification
You want your next step to be the right one. You've worked hard to get where you are today. And now you're ready to use your unique skills, talents and personality to achieve great things. RSM is a place where you are valued as an individual, mentored as a future leader, and recognized for your accomplishments and potential. Working directly with clients, key decision makers and business owners across various industries and geographies, you'll move quickly along the learning curve and our clients will benefit from your fresh perspective.
Experience RSM US. Experience the power of being understood.
RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.
Explanation Of Benefits (Eob)
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