Saint Barnabas Health Care System Physician Billing Auditor in Oceanport, New Jersey
Physician Billing Auditor
Req \#: 0000067459
Facility: RWJBarnabas Health Corporate Services
2 Crescent Place, Oceanport, NJ 07757
Summary of Job Function:
Prepares and conducts employed provider billing audits according to the current year Work Plan, in accordance with new provider on-boarding (pre and post-acquisition), and as per Compliance and/or Management requests.
Reviews ICD-10-CM coding performed by employed providers and/or affiliate staff for accuracy and completeness.
Reviews HCPCS/CPT coding performed by employed providers and/or affiliate staff for accuracy and completeness.
Reviews Evaluation and Management (E/M) coding performed by employed providers and/or affiliate staff for accuracy and completeness.
Works collaboratively with providers and affiliate staff to promote and ensure correct and compliant coding and billing practices.
Works collaboratively with Physician Billing Educators providing audit results, coding references, and other materials associated with completed reviews of employed providers, including research, and associated research documentation.
Prepares detailed reports of review activities.
Maintains proper computer and written records of all review activity.
Effectively communicates coding recommendations and reasoning to medical staff members and others.
Performs regulatory coding research for Compliance Department and/or employed providers and affiliate staff.
Performs physician RAC coding reviews and prepares appeals when warranted.
Assists internal and external Compliance counsel in external agency investigations as required.
Corresponds with AMA, etc. with coding questions as necessary.
May be required to assist in the formation of Corrective Action Plans for the employed physicians and affiliate staff.
May be required to perform other related duties.Job Qualifications/Education/Training/Certification/Licensure:
Must have a minimum of an Associate s Degree; Bachelor s degree preferred.
Must have advanced coding education and training with strong foundation in E/M coding.
Prior E/M physician auditing experience preferred.
Prior supervisory experience and/or coding consultant experience preferred.
Must have excellent interpersonal, oral, and written communication skills. Must have excellent organizational and time management skills. Must be able to work independently with minimal supervision.
Coding certification required (e.g. CCS, CCS-P, CPC, COC, CEMC), RHIT, RHIA, and/or RN also encouraged.
Must be able to utilize a personal computer with Windows and Microsoft Office software, especially Word, Excel and PowerPoint. Must be able to utilize the 3M Coding and Reimbursement Software system.
Must be able to utilize 3 M SoftMed, Cerner, Allscripts SCM and other electronic medical records systems for remotely reviewing of medical records.
Work Environment and Hazards:
Typical work environment with copiers, fax machines, computers, etc. May travel to various facilities and employed providers office locations with the RWJBH System.
Special Physical Demands:
Must be able to carry or transport coding books, a personal computer, etc. May need to carry or transport medical records. May be required to sit for extensive periods of time.
Work Contact Group:
Other Corporate Coding staff, Compliance Department staff, employed provider and affiliate staff. Possibly interact with Physician Advisors, Site Directors, and others.
Job Specific Requirements:
Conducts audits of inpatient, outpatient and physician office medical records for the accuracy and completeness of ICD-10-CM, CPT and E/M coding in a professional manner.
Prepares written reports and documents on reviews conducted.
Effectively communicates recommendations and the reasoning behind each.
May prepare physician coding and billing Corrective Action Plans. May also perform follow up reviews in connection with same.
Conducts thorough and appropriate research as needed in association with coding audits.
Work collaboratively with Lead Physician Reviewer in preparation of annual Work Plan, and review assignments.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
We offer a great work environment, competitive rates and excellent benefits, including:
Vacation/Personal/Holiday/Sick Time Off
Short & Long Term Disability
Basic Life & Accidental Death Insurance
Health Care/Dependent Care Flexible Spending Accounts
RWJBarnabas Health is an Equal Opportunity Employer.