Revenue Auditor (Full Time/ Day Shift)
HOURS: 1.0 FTE/ 40 hours per week
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.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- 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.
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
- 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: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely. This position is located in Lancaster, PA. #LI-MD1
PENN MEDICINE LANCASTER GENERAL HEALTH offers the following benefits to employees:
- 100% Tuition Assistance at The Pennsylvania College of Health Sciences
- Paid Time Off and Paid Holidays
- Shift, Weekend and On-Call Differentials
- Health, Dental and Vision Coverage
- Short-Term and Long-Term Disability
- Retirement Savings Account with Company Matching
- Child Care Subsidies
- Onsite Gym and Fitness Classes
Posted on 01/27/2022
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.