Billing and Coding Auditor - Generous Compensation

Billing and Coding Auditor
Iselin, NJ 08830 (Hybrid)

SUMMARY:

• The Manager, Billing & Coding Audit coordinates the surveys/audits including tracking deliverables, tasks, and corrective actions
• Manages the billing and coding audit processes including reviewing, analyzing, and reporting findings internally to the CCO to ensure compliance with Federal, State, payer, and institutional requirements. Through the review process, the Manager may also identify opportunities to improve coding practices and related business processes or issues needing further review, assessment and follow-up
• This position supports the Compliance team in its mission to assure that practitioners and staff are knowledgeable as to the requirements for documenting, coding, and billing clinical services in a complex and ever-regulatory environment

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Manages ongoing auditing and monitoring in accordance with the established Annual Audit Work Plan and relevant policies and procedures, including coordination of physician pre-billing reviews and follow-up on corrective actions identified. Ensures timely execution of compliance program elements and maintenance of established compliance metrics
• Works on complex and unique issues related to compliance, making sound judgments based on information provided with or without supporting data and analysis. Oversees and facilitates requests and referrals for coding and ad hoc trainings received from faculty practice plan staff
• Assists in the development of appropriate policies and educational documents related to compliance with documentation and coding requirements
• Works with external resources and auditors in focused audits, analyzes results and provides recommendations to issues identified. Makes appropriate recommendations to address and resolve issues identified to mitigate compliance vulnerabilities. Follows through on recommendations to ensure implementation
• Develops and implements processes that will effectively monitor/track compliance requirements, including reports, performance metrics and scorecards for the Billing/ Coding Audit team
• Prepares summary of physician audit activities and reconciles annual training logs. Maintains ongoing list of projects and deliverables. Professionally communicates both verbally and in writing and prepares formal presentations with executive summaries and recommendations based on audit results
• Provides education on coding and documentation requirements as part of New Hire Orientation for staff, one-on-one sessions for newly hired clinicians, and in-services on regulatory changes as appropriate and timely
• Services as a focal point providing sound consultation and advise on billing and coding questions for clinicians, supporting staff, and revenue cycle department
• Manages weekly quality reporting notifications (MIPS) for practice clinical operations
• Oversees the execution of other tasks or special projects when required by the CCO including but not limited to internal investigations related to coding/ documentation compliance, focused reviews of specific risk areas or providers
• Performs other job-related duties as required

QUALIFICATIONS:
Education:

• Bachelor's degree or equivalent

Experience/Skills:

• 3+ years of relevant audit experience in ambulatory setting
• Demonstrated physician practice business office operations/ revenue cycle experience
• Specific thorough understanding of physician and hospital coding, claim forms, payer EOBs, and reimbursement methodologies
• Must have working knowledge of Microsoft Office applications
• Strong analytical and problem-solving skills required including experience auditing and drilling down large quantities of data

Licensure/Certification:

• Medical Coding Certification (CPC, RHIT, or RHIA)
• Medical Coding Certification in Ophthalmology

BENEFITS:

• Medical, Dental, Vision, FSA, Short-Term Disability, 401k w/match, Life Insurance

req24-00523