Auditor - Educator II
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Charlotte, NC, United States
Job ID: 29173
Job Family: Financial Services
Status: Full Time
Job Type: Regular
Department Name: 51011028343108-Corporate Compliance
This position supports the Post-Acute Care Compliance team. Provides coding, billing and compliance support and training to clinicians, support staff and administration of the Post-Acute Care (PAC) service lines and facilities across all Atrium Health Markets; monitors coding and billing activities to verify that activities performed are in compliance with applicable federal and state statutes/regulations, as well as address preventable revenue loss; develops education/training programs, coding tools and resources to help achieve the goal to be consistent, complete and accurate in coding and reimbursement.
- Maintains a working knowledge of the ICD-9-CM, ICD-10-CM and CPT/HCPCS coding principles and the AMA/CMS Documentation Guidelines (DGs); keeps current on any changes to payer-specific reimbursement policies; acts as a coding resource, responding to inquiries on a timely basis.
- Routinely creates and conducts reviews, audits and investigations; provides written reports with review findings to leadership; provides follow-up education based on review findings.
- Reviews and analyzes denial information from third party payers to understand reasons for denials; coordinates with management and PFS to address operational issues that are contributing to the denials; supports appeal processes, as indicated.
- Monitors regulatory and reimbursement information to keep informed of relevant changes/updates.
- Analyzes comparative data to identify utilization trends and coding patterns that may provide clues on where to focus further analysis and education.
- Develops Job Aids, Documentation Templates, that will assist compliance in capturing identified revenue.
- Researches, develops and delivers education/training, as indicated.
- Identifies business practices and processes that need investigation and/or intervention.
- Maintains a working knowledge of the clinical and billing systems, functionality and recommends/coordinates changes in billing edit rules.
- Establishes and maintains a positive and professional working relationship with teammates.
- Assists management with research on difficult claims and unusual billing situations; performs special demand audits as requested.
Additional Essential Functions
- Works with the PAC Compliance Officers to develop, implement and maintain effective compliance programs across each of the PAC service lines, including Inpatient Rehabilitation, Outpatient Rehabilitation, Skilled Nursing Facilities, Home Health, Home Medical Equipment, Home Infusion and Hospice.
- Acts as a liaison between the Enterprise Compliance team and the PAC service lines. Provides support, assistance and customer service to constituents
- Creates and maintain auditing and monitoring programs to assess compliance with Atrium Health policies, regulatory requirements, compliance processes and other requirements, as identified. At a minimum, this position will routinely assess adherence to documentation requirements related to Medicare Part A, Medicare Part B and Medicare Advantage payers.
- Completes auditing and monitoring activities, produces and reports monitoring data to the PAC Compliance Officers, PAC leaders, and the respective Compliance Council on an ongoing and routine basis.
- Provides education and guidance to PAC areas in response to identified issues or process concerns, including participating in the design of responsive action plans.
- Keeps current knowledge of, and serves as a resource related to, the regulatory requirements and related operational processes and other compliance issues as identified. Assists with connecting partners with appropriate leaders/areas when concerns are relayed.
- Identifies and communicates irregularities and participates in corrective actions in a timely manner. For example, errors or inconsistencies impacting coding and billing should immediately be reported to the PAC Compliance Officer, appropriate PAC leaders and the corresponding Billing, Coding leaders. Assists with oversight of billing/claims corrections to make certain they occur timely.
- Assists the PAC teams with response to external inquiries and audits, as needed.
- Supports the PAC Compliance Officer in other duties as assigned.
- In all decisions and communications, demonstrates the commitments expressed in the Atrium Health Code of Conduct.
Ability to sit and concentrate for extended periods of time. Frequent reaching and handling of reports and/or medical records. Position may work remotely after an introductory period. Local travel will be required periodically for audits, as indicated. Ability to work under pressure and meet deadlines.
- HS Diploma or equivalent required. Bachelor’s degree preferred. Healthcare consulting preferred.
- CPC, CCS-P, RHIT or RHIA credential preferred. Knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding classification systems required. Minimum of 2 years coding experience preferred. Clinical education and work experience PAC area may be sufficient for candidates with a clinical audit background and a willingness to obtain coding certification within 1 year.
- At least 1 year of work experience in one PAC area required, experience in multiple PAC areas preferred.
- Knowledge of medical terminology and anatomy and physiology required. Prior billing system experience preferred. Knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing.
- Excellent communication, analytic, and writing skills required.
- Must be proficient with Microsoft Office products, in particular Microsoft Word, Excel and Power Point applications.
- Thrives in a fast-moving, dynamic environment