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Revenue Auditor


At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job. We ask that you Live Your Legacy by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.

We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have achieved four-years of Magnet ® status with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.

Join us and be part of a team that empowers you to do more than your job and encourages you to:

Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.

Company

Lancaster General Hospital

Cost Center

2040 Patient Financial Services

Supervisory Organization

Patient Financial Services-Revenue Integrity

Grade

G13

Summary

This position is located in Lancaster, Pa

HOURS: Full Time- Day Shift- Work from home flexibility

POSITION SUMMARY:  Research and analyze data to ensure correct coding and billing. Provide recommendations to improve reimbursement and streamline processes. Assist other areas, both internal and external, in relation to payer audits, insurance appeals, denials and correct billing processes.  Support Patient Financial Services (PFS) in identifying areas in which over/under charging is occurring.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

  • Perform coding and billing reviews of clinical departments’ charges to identify opportunities to improve charge capture through better documentation or utilization of departmental billing systems.  Evaluate documentation to prevent denials and facilitate complete billing.
  • Provide guidance on correct billing processes to clinical departments and facilities.
  • Coordinate chargemaster error findings with chargemaster team.  Assist in researching errors to ensure proper billing and compliance guidelines are followed.
  • Identify trends associated with incorrect pricing, coding, quantity, and/or billing.  Perform research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.
  • Answer questions from other departments about how to properly charge for services.  Assist in researching new services to ensure proper coding/charging is followed.
  • Develop recommendations to improve reimbursement, to decrease re-work, or to streamline processes.  Assist with developing action plans for revenue integrity improvement projects.
  • Review payer updates and distribute to departments as they apply.
  • Research compliance issues.  Respond to payer compliance audits with next step recommendations and improvements.
  • Act as primary support to the Accounts Receivable team for incoming insurance appeal and audit requests.  Provides guidance regarding resolution to ensure proper payment is received for services provided.
  • Coordinate audits of patient accounts with external insurance auditors.  Review findings and correct charges as appropriate in conjunction with medical documentation, payer contracts, payer policies, and billing/coding guidelines.
  • Ensure work queues are maintained and worked within appropriate time frames.  Communicate to departments when time frames are not met.  Provide training when needed.
  • Develop realistic timeline and work plan for all assignments.
  • Assist with other special projects as requested.
  • Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

  • HS diploma or equivalent (GED)
  • Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician (CCS-P) through AHIMA (American Health Information Association), or certified by AAPC (American Association Professional Coders) with certification as a Certified Professional Coder (CPC) – Hospital Outpatient
  • Formal education in ICD-10-CM/PCS coding, CPT coding, medical terminology, anatomy and physiology
  • Three (3) to five (5) years experience in CPT, ICD-10-CM and ICD-10-PCS, MS-DRG assignment/analysis coding principles/guidelines
  • Knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing
  • Three (3) to five (5) years experience in the healthcare industry
  • Ability to manage multiple tasks simultaneously, maintain attention to detail and adjust to issues as needed in a dynamic work environment as well as the ability to prioritize and effectively anticipate and respond to issues as they arise
  • Strong written and verbal skills
  • Strong interpersonal skills

PREFERRED QUALIFICATIONS:

  • One (1) to three (3) years of experience working with hospital technical charge capture
  • One (1) to three (3) years of Revenue Cycle Experience
  • One (1) to three (3) years of ICD-10-CM Coding Experience
  • One (1) to three (3) years of CPT-4 Coding Experience
  • Clinical background and knowledge acquired by serving in a CMA, LPN or RN role

Disclaimer

Lancaster General Health invests in the Employee Total Rewards by providing our employees with a competitive comprehensive packaging inclusive of:

Generous paid time off, Health, Dental, Vision, Wellness and Prescription, Retirement with an employer match and basic contribution, Tuition discounts and a tuition free affiliation with Pennsylvania Health Sciences. We also provide subsidized childcare, life insurance and career advancement opportunities for long term career growth.

Penn Medicine Lancaster General Health is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

Search Firm Representatives please read carefully: Penn Medicine Lancaster General Health is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at Penn Medicine Lancaster General Health via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of Penn Medicine Lancaster General Health, and no fee will be paid in the event the candidate is hired by Penn Medicine Lancaster General Health as a result of the referral or through other means.

BURLE Full Time Posted on 09/09/2020