Children's Clinics
Revenue Cycle Auditor (Healthcare)
Children's Clinics is seeking a full time Revenue Cycle Auditor.
As a member of the Business Services team, the Revenue Cycle Auditor is responsible for pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper coding and charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is also responsible for working collaboratively with other departments in the resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. The Revenue Cycle Auditor will also serve as an audit outcome educator with clinical staff in clinic, coders and department settings. The successful candidate will possess coding and auditing experience, thorough knowledge of ICD and CPT application, the ability to communicate effectively with internal and external customers, ability to develop procedures and training materials, skilled in Health Information Management (HIM), Facility/Physician billing, Charge Description Master (CDM), Denials Management, Charge Integrity and Financial Analysis.
Associate's degree or equivalent in healthcare or managed care environment, CPC or CCA and two or more year's healthcare or managed care systems experience required. Knowledge of Payers (AHCCCS, Medicare, CRS, and commercial plans), experience with Accounts Payable and posting, and strong technical skills (Microsoft Office Suite) preferred. Experience working in a Practice Management System (NextGen) a plus.
Please apply on-line at https://www.childrensclinics.org/about/careers/
JOB TITLE: Revenue Cycle Auditor JOB CODE: Z1005
DEPARTMENT: Revenue Cycle Manager FLSA: Non-exempt
REPORTS TO: Business Services REVIEWED: 01/2020
SUMMARY:
This position is responsible for responsible for pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper coding and charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is also responsible for working collaboratively with other departments in the resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. The Revenue Cycle Auditor will also serve as an audit outcome educator with clinical staff in clinic, coders and department settings.
ESSENTIAL FUNCTIONS:
Provides pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper coding, charge capture, billing in accordance with standard billing policies and reimbursement principles.
Responsible for working collaboratively with other departments in the resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed.
Performs data quality monitoring activities.
Assists in promoting accurate diagnostic information and complete documentation by physicians, nurses and other professionals as required.
Attends continuing education sessions designed to keep coders abreast of the newest concepts and changes in medical coding.
Proficient knowledge of anatomy, physiology and medical terminology. Analyzes medical information from medical records.Monitors and analyzes current industry trends and issues for potential organizational impact.
Provides clear short- and long-term direction, guidance to the Business Services Manager and senior management relating to revenue benefits and audit findings.
Prepares detailed reports that provide a range of data to assist management in evaluating financial performance and making recommendations to the Revenue Cycle Manager.
Provides technical guidance regarding interpretation of state, federal benefits legislation, ensures organizational compliance, and submits regulatory reports as required.
Develops contingency plans and responds to unforeseen circumstances utilizing planned resources.
Serves as an audit outcome educator with clinical staff in clinic, coders and department settings.
Adheres to the Clinic's organizational and department-specific safety, confidentiality, values, policies and standards.
Performs related duties as assigned.
This role may encounter Protected Health Information (PHI) as part of regular responsibilities.
KNOWLEDGE, SKILLS AND ABILITIES:
Thorough knowledge of ICD and CPT application, correct practices, and tools utilized within the hospital or healthcare industry is required
Ability to code records utilizing established coding guidelines and resources.
Ability to understand basic anatomy, physiology, and medical terminology Knowledge of computer application software such as Microsoft Office products
Skill in the developing procedures and training material Ability to audit physician coding for errors and discrepancies.
Skills with Health Information Management (HIM), Facility/Physician Billing, Charge Description
Master (CDM), Denials Management, Charge Integrity, Financial Analysis
MINIMUM QUALIFICATIONS
Education:
Associate's degree or equivalent in healthcare or managed care environment required
Experience:
Two or more year's healthcare or managed care systems experience required
Licenses and Certificates:
CPC or CCA required
AGE OF PATIENTS ATTENDED BY EMPLOYEE IN THIS POSITION
Check all that apply:
_X_ N/A Neonatal (newborn) Pediatric (birth-13) Young Adult
(14-21) Adult (21-65)
FINGERPRINT CLEARANCE
Employees are required to maintain a current Department of Public Safety Level 1 Fingerprint Clearance Card. Proof of a current fingerprint clearance card must be received within 90 days of employment.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment described here are representative of that which an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel and talk and hear. The employee is occasionally required to stand and walk.
Specific vision abilities required by this job include close vision, distance vision, color vision and ability to adjust focus.
While performing the duties of this job, the employee may potentially be exposed to infectious organisms during routine and emergency situations. The noise level in the work environment is usually moderate.
BLOODBORNE PATHOGEN CATEGORY: 3
Category 1: Performs tasks that involve exposure to blood, body fluids or tissue. Use of appropriate protective measures should be required.
Category 2: Performs tasks that involve no exposure to blood, body fluids or tissue but employment may require performing unplanned Category 1 tasks. The normal work routine involves no exposure to blood, body fluids or tissue but exposure or potential exposure may be required as a condition of employment.
Appropriate protective measure should be readily available.
Category 3: Performs tasks that involve no exposure to blood, body fluids or tissue and Category 1 tasks are not a condition of employment. The normal work routine involves no exposure to blood, body fluid or tissues.
Children's Clinics reserves the right to make changes to this document at any time in accordance with business needs. This document is not intended to list a l duties of the job. It is descriptive only of the chief duties and responsibilities.
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