Senior Auditor Facility and Professional Full-time Job
Nov 1st, 2022 at 18:44 Home Health Care Pembroke Pines 103 views Reference: 790Job Details
Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.
Summary:
Performs facility and professional audits to evaluate adequacy and accuracy of clinical documentation in support of services rendered. Working knowledge required for this position is advanced expertise in regards to medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations. Effectively works with multiple business units and provides recommendations toward continuing improvement of coding and charging compliance.
Responsibilities:
1.
Audits accuracy of coding against medical records and billing documents to include ICD-10, CPT4, Evaluation & Management, HCPCS, medical supplies, orders, quantities, medical record completeness, UB04, revenue codes for facility and professional coders.
2. Conducts education sessions for facility and professional coders based on the audit findings and as needed to reinforce proper documentation and coding consistent with department policies, State and Federal regulatory and reimbursement guidelines. Maintains compliance while optimizing appropriate revenue opportunities.
3.Researches CMS and NGS Medicare regulations, guidelines, bulletins and other publications for impact to hospital and professional services. Monitor list serves such as CMS, Medicare, NGS, AAPC etc. and third party payers for coding and billing guidelines and regulations, professional peer organizations' practices/policies/guidelines to help keep hospital coders current with coding and regulatory requirements and accepted compliance practices. Stay current with OIG Work Plan.
4. Collaborate with the hospital and physician coding management team members to identify errors, patterns, trends and variations in coding or documentation. Provides recommendations to Supervisor, Manager or Director to improve coding and documentation practices which can affect reporting patient’s condition and compliant reimbursement.
5. Performs coding and charging of complex encounters to include ICD-10, CPT4 and medical supplies. The cases include, but are not limited to, complex services in interventional cardiology, vascular and radiology.
6. Exhibits strong competency in use of computer systems and applications that are related to the position.
7. Attends coding educational sessions as requested. Provides coding staff with updates from educational sessions attended.
8.Achieves organization's established expectations in regard to customer service, teamwork and safety.
9.Fulfills all compliance responsibilities related to the position.
10.Achieves the organization's established expectations in regard to customer service, teamwork and safety.
11.Performs other duties as assigned.
Criteria Desired (Not Required):
Associates’ Degree or higher. Course work in Anatomy and Physiology.
Communications: Daily
Verbal Communications (daily)
Written Communications (daily)
Participating in meetings (at least weekly)
Location: REMOTE-FL11
Work Type: Full-Time
Standard Hours: 40.00
FTE: 1.000000
Work Schedule: Day 10
Work Shift: 8:00 am to 4:30 pm
Org Unit: 1853
Department: CODERS - PROFESSIONAL & FACILITY CHARGING and CODING
Exempt: No
Grade: S9
Salary Range:
27.9100 - 51.8300
Working conditions:
Essential:
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.
Summary:
Performs facility and professional audits to evaluate adequacy and accuracy of clinical documentation in support of services rendered. Working knowledge required for this position is advanced expertise in regards to medical terminology, anatomy, physiology, documentation, coding guidelines, state and federal regulations. Effectively works with multiple business units and provides recommendations toward continuing improvement of coding and charging compliance.
Responsibilities:
1.
Audits accuracy of coding against medical records and billing documents to include ICD-10, CPT4, Evaluation & Management, HCPCS, medical supplies, orders, quantities, medical record completeness, UB04, revenue codes for facility and professional coders.
2. Conducts education sessions for facility and professional coders based on the audit findings and as needed to reinforce proper documentation and coding consistent with department policies, State and Federal regulatory and reimbursement guidelines. Maintains compliance while optimizing appropriate revenue opportunities.
3.Researches CMS and NGS Medicare regulations, guidelines, bulletins and other publications for impact to hospital and professional services. Monitor list serves such as CMS, Medicare, NGS, AAPC etc. and third party payers for coding and billing guidelines and regulations, professional peer organizations' practices/policies/guidelines to help keep hospital coders current with coding and regulatory requirements and accepted compliance practices. Stay current with OIG Work Plan.
4. Collaborate with the hospital and physician coding management team members to identify errors, patterns, trends and variations in coding or documentation. Provides recommendations to Supervisor, Manager or Director to improve coding and documentation practices which can affect reporting patient’s condition and compliant reimbursement.
5. Performs coding and charging of complex encounters to include ICD-10, CPT4 and medical supplies. The cases include, but are not limited to, complex services in interventional cardiology, vascular and radiology.
6. Exhibits strong competency in use of computer systems and applications that are related to the position.
7. Attends coding educational sessions as requested. Provides coding staff with updates from educational sessions attended.
8.Achieves organization's established expectations in regard to customer service, teamwork and safety.
9.Fulfills all compliance responsibilities related to the position.
10.Achieves the organization's established expectations in regard to customer service, teamwork and safety.
11.Performs other duties as assigned.
Criteria Desired (Not Required):
Associates’ Degree or higher. Course work in Anatomy and Physiology.
Communications: Daily
Verbal Communications (daily)
Written Communications (daily)
Participating in meetings (at least weekly)
Location: REMOTE-FL11
Work Type: Full-Time
Standard Hours: 40.00
FTE: 1.000000
Work Schedule: Day 10
Work Shift: 8:00 am to 4:30 pm
Org Unit: 1853
Department: CODERS - PROFESSIONAL & FACILITY CHARGING and CODING
Exempt: No
Grade: S9
Salary Range:
27.9100 - 51.8300
Working conditions:
Essential:
- Significant manual skills / motor coord & finger dexterity
- Sedentary/light effort. May exert up to 10 lbs. force
- Generally pleasant working conditions.
- Little or no potential for occupational risk
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.
Company Description
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