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Physician Billing Auditor

4 months ago

Oceanport NJ, United States RWJBarnabas Health Corporate Services Full time

Job Overview: The Physician Billing Auditor 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. Qualifications: Required: Must have a minimum of an Associate s Degree Must have advanced coding education and training with strong foundation in E/M coding. Preferred: Bachelor s degree preferred. Prior E/M physician auditing experience preferred. Prior supervisory experience and/or coding consultant experience preferred. Must have excellent interpersonal skills. Certifications and Licenses Required: Coding certification required e,g, CCS, CCS-P, CPC, COC, CEMC; RHIT, RHIA and/or RN also encouraged Essential Functions: 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. Other Duties: 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. At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health. Paid Time Off (PTO) Medical and Prescription Drug Insurance Dental and Vision Insurance Retirement Plans Short & Long Term Disability Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more Choosing RWJBarnabas Health RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer