Edward Elmhurst Health
Senior Auditor, Billing Compliance
Edward Elmhurst Health, Chicago, Illinois, United States, 60290
Senior Auditor, Billing Compliance
Position Highlights:Position: Senior Auditor, Billing Compliance
Location: Evanston, IL
Full Time/Part Time: Full Time
Hours: Monday-Friday, 8:00am-4:30pm
Travel: travel to other locations in the health system may be required
What you will do:Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments, as assigned.
Analyze source documents (including but not limited to, progress notes, operative reports, pathology reports, etc) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy.
Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation by applying appropriate corporate policy, state/federal regulation, coding rules, commercial payer guidelines, and/or Medicare/Medicaid guidelines.
Conduct internal Compliance investigations in response to external concerns while maintaining a strict level of confidentiality.
Identify trends or patterns of questionable coding and billing practices for the System and report issues to Manager.
Document relevant findings for all audits and investigations conducted, including pertinent details from interviews, claim audits, control assessment, root cause analysis, and corrective action plans.
Calculate reimbursement impact and statistical error rates based on findings in audits and investigations.
Facilitate communication of audit and investigational activities between internal/external customers.
Keep current on topics related to coding, billing, and documentation requirements.
Work on special projects related to Billing Compliance as assigned by Manager.
What you will need:Education: Bachelor’s degree, required
Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC), required.
Experience:3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
Experience with analyzing and/or auditing Revenue Cycle functions.
Experience with compliance auditing, facility and physician coding/billing practices preferred.
Related experience in physician and hospital inpatient/outpatient medical billing is a plus.
Unique or Preferred Skills:Skilled at medical coding and related research & analysis.
Ability to interpret a variety of clinical documents and effectively communicate technical coding information.
Benefits:Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care.When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities.Diversity, equity and inclusion is at the core of who we are; we believe that our strength resides in our differences.EOE: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
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Position Highlights:Position: Senior Auditor, Billing Compliance
Location: Evanston, IL
Full Time/Part Time: Full Time
Hours: Monday-Friday, 8:00am-4:30pm
Travel: travel to other locations in the health system may be required
What you will do:Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments, as assigned.
Analyze source documents (including but not limited to, progress notes, operative reports, pathology reports, etc) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy.
Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation by applying appropriate corporate policy, state/federal regulation, coding rules, commercial payer guidelines, and/or Medicare/Medicaid guidelines.
Conduct internal Compliance investigations in response to external concerns while maintaining a strict level of confidentiality.
Identify trends or patterns of questionable coding and billing practices for the System and report issues to Manager.
Document relevant findings for all audits and investigations conducted, including pertinent details from interviews, claim audits, control assessment, root cause analysis, and corrective action plans.
Calculate reimbursement impact and statistical error rates based on findings in audits and investigations.
Facilitate communication of audit and investigational activities between internal/external customers.
Keep current on topics related to coding, billing, and documentation requirements.
Work on special projects related to Billing Compliance as assigned by Manager.
What you will need:Education: Bachelor’s degree, required
Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC), required.
Experience:3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience.
Experience with analyzing and/or auditing Revenue Cycle functions.
Experience with compliance auditing, facility and physician coding/billing practices preferred.
Related experience in physician and hospital inpatient/outpatient medical billing is a plus.
Unique or Preferred Skills:Skilled at medical coding and related research & analysis.
Ability to interpret a variety of clinical documents and effectively communicate technical coding information.
Benefits:Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care.When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities.Diversity, equity and inclusion is at the core of who we are; we believe that our strength resides in our differences.EOE: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
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