Specialist Audit Billing/Coding
Company: Cleveland Clinic
Posted on: March 24, 2020
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
- 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
- Provides feedback, education and outreach efforts to
appropriate personnel relating to audit findings and trends on
- 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
- 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
- Proven ability to meet deadlines and change work priorities as
- Excellent oral, written and presentation skills.
- Ability to develop and maintain strong professional
- 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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