Compliance Auditor – OP-Ambulatory Services bei Baptist Health Care Corporation
Baptist Health Care Corporation · Pensacola, Vereinigte Staaten Von Amerika · Onsite
- Junior
- Optionales Büro in Pensacola
This entry-level position is responsible for auditing outpatient and ambulatory services claims to federally funded healthcare payors across the Baptist Physician Enterprise (BPE) organization. The position audits and provides feedback as needed and attends BPE department meetings as needed to respond to compliance related coding and billing questions and provide feedback on audit findings and necessary remediation/corrective action requirements. The position analyzes coded records for compliance with federal, state and third-party insurer rules and regulations and note trends. The position educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements; and maximize reimbursement. This role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards.
Responsibilities
- Performs routine and targeted audits of patient services and corresponding claims submitted to government payors.
- Audits outpatient (OP)/ambulatory service claims to assure a minimum of 95% accuracy and recommends corrective action, education, and training related to audit results.
- Audits the assignment of International Classification of Diseases 10-CM (ICD-10) diagnostic and ICD-10-PCS procedural codes, Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes in an accurate and productive manner on sampled outpatient/ambulatory cases.
- Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided.
- Utilizes Healthicity or other compliance and audit systems, develops and maintains comprehensive audit reports and documentation of each audit performed, cases sampled, and audit findings.
- Meets with audited providers/department leadership to present audit findings and required remediation/corrective actions to cure coding and billing errors; effectively educates and promotes awareness of compliant billing and coding requirements.
- Provides information to physicians and other health care staff regarding current coding practices and changes in state and federal regulations and guidelines.
- Researches and resolves problems referred by auditees and provides prompt feedback.
- Serves as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and billing requirements.
- Participates in and provides education sessions as needed on specific coding topics at huddle meetings and other forums.
- Communicates with physicians and other health care staff to obtain missing information or to clarify existing information.
- Responsible for the identification of claims that require correction or other reimbursement related remedies to cure coding and billing errors identified through audit activities.
- Responsible for operational excellence; ensures the delivery of quality audit services in accordance with applicable policies, procedures, and professional standards.
Qualifications
Minimum Education
- Bachelor's Degree Health Information Management, Five years of related experience maybe considered in lieu of degree, Related field Required
Minimum Work Experience
- 5 years Experience in a healthcare setting Required
- 1-3 years Healthcare coding and billing experience Preferred
- Prior experience with the following applications and systems: Healthicity, Altera Sunrise (formerly Allscripts), Hyland MRM, Clintegrity, FinThrive, and MS Office Suite and Excel in particular Preferred
Company
Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida.
Baptist Health Care, Inc. is an Equal Opportunity Employer. BHC maintains and enforces a policy that prohibits discrimination against any workforce members or applicants for employment because of sex, race, age, color, disability, marital status, national origin, religion, genetic information, or other category protected by federal, state or local law.
