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Specialist Audit Billing/Coding

Company: Cleveland Clinic
Location: Akron
Posted on: March 24, 2020

Job Description:

Job Summary:Under the direction of the Supervisor, Claims Denial and Audit, the Audit Specialist, Billing and Coding is responsible for managing the day-to-day billing and coding auditing efforts for the Patient Financial Services department. The Audit Specialist responds to claim edits related to Medical Necessity rules and Correct Coding Initiative (CCI) rules. The Audit Specialist evaluates billing and coding and provides departmental education and support. The Audit Specialist responds to inquiries and provides guidance focused on compliance and coding rules.

  • Reviews Medical Necessity and CCI edits and assists in obtaining accurate information for compliant billing.
  • Participates in review and research of new services under consideration for addition to the CDM.
  • Serves as a resource to AGHS management and clinical staff by monitoring, educating and providing support that will assist with accurate billing and coding practices. Shares new regulations with impacted departments.
  • Updates and maintains intranet resource website of LCDs for all revenue cycle and clinical departments.
  • Performs Verification of Hours (VOH) on Medicaid claims.
  • Reviews Short Term Observation (STO) charts for procedures performed. Captures appropriate charges in accordance with Medicare billing rules and regulations.
  • Works closely with Health Information Management (HIM), Patient Financial Services (PFS), Patient Access and the clinical departments on addressing billing/coding trends and provide support.
  • Provides feedback, education and outreach efforts to appropriate personnel relating to audit findings and trends on billing practices.
  • Assists with the completion of the annual compliance work plan that consists of clinical, coding and billing reviews.
  • Serves as a resource for coding questions and concerns. Provides guidance for billing.
  • Uses due diligence and all available resources to ensure billing codes (e.g., revenue codes, CPT codes) accurately reflect the services provided by AGHS.
  • Supports compliance efforts by adhering to applicable organizational guidelines as well as federal, state and local laws. Maintains privacy and confidentiality. Acts with integrity and maintains high ethical standards. Works to protect the assets of the organization.
  • Keeps abreast of compliance activity/trends to ensure up-to-date knowledge of compliance information. Shares information with the applicable Revenue Cycle and ancillary department staff. Participates in educational and training opportunities.
  • Completes mandatory education and training in order to maintain organization and department specific competencies and requirements. Maintains applicable certification/licensure.
  • Follows hospital and department policies and procedures with special attention to attendance and punctuality, confidentiality, dress code and display of ID badge.
  • Other duties as assignedEducation:Certifications:
    • RHIT, CCS or other coding certification.Complexity of Work:
      • Ability to support others through thorough auditing efforts, timely feedback and educational support.
      • Knowledge and understanding of verification of observation hours (VOH).
      • Proven ability to meet deadlines and change work priorities as needed.
      • Excellent oral, written and presentation skills.
      • Ability to develop and maintain strong professional relationships.
      • Demonstrated collaboration with others.Work Experience:
        • two years coding experience.Demonstrated experience with patient accounts and medical records audit analysis.
        • Demonstrated ability to use the utmost discretion and maintain the strictest confidentiality when investigating, discussing, and managing job duties.
        • Experience with Microsoft Office programs including proficiency in Access, Excel, PowerPoint, and Word.Physical Requirements:Personal Protective Equipment:
          • Follows standard precautions using personal protective equipment as requiredThe policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinics Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities

Keywords: Cleveland Clinic, Akron , Specialist Audit Billing/Coding, Accounting, Auditing , Akron, Ohio

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