Lead Medical Coder/Auditor

4 weeks ago

Fairborn, United States Wright State Physicians Inc Full time
Job DescriptionJob Description

Wisdom * Integrity * Compassion

At Wright State Physicians our core values are #Wisdom, #Integrity, and #Compassion. If you also share these core values, come work with us.

General Summary: An exempt position managing billing and coding staff. Provides, coordinates, schedules, and performs coding and documentation reviews of medical/patient records to ensure provider billing practices are compliant with applicable rules and regulations.

Benefits: At Wright State Physicians our core values are Wisdom, Integrity, and Compassion. We value our employees, patients, and students as our most important mission/purpose. We offer a competitive salary and excellent full-time benefits, including:

  • Medical Insurance with HSA
  • Dental Insurance
  • Vision Insurance
  • Vacation
  • 10 Paid Holidays
  • Sick Pay and Short and Long Term Disability
  • Tuition Remission with Wright State University
  • A generous 7.5% company contribution to an employee 401(a) with 100% vesting
  • 403(b)
  • and more

Essential Job Responsibilities:

  1. Responsible for coordinating, scheduling, and implementing complex physician billing compliance reviews in collaboration with the Manager of Coding, Compliance, and Auditing and the Director of Revenue Cycle.
  2. Analyzes data/reports from compliance monitoring activities to identify trends, issues and risk areas.
  3. Reviews documentation to establish compliance with billing guidelines, evaluation and management documentation guidelines, and correct coding standards based on government and third party payer requirements.
  4. Analyze audit results and report to the Manager of Coding, Compliance, and Auditing and the Director of Revenue Cycle all audit findings and violations. Develops action plan and informs the Manager of Coding, Compliance, and Auditing. Monitor any issues found in the audit and set up a process to monitor problem areas.
  5. Monitors quality and productivity of staff including audits on staff work in collaboration with the Manger of Coding Compliance
  1. Meets with providers to provide focused education audit reviews to enhance compliance.
  2. Maintains working knowledge of CMS 1500 billing guidelines, CPT/HCPCS codes, HCPCS Level II codes, modifiers, etc. that are needed to ensure proper billing and coding guidelines
  3. Serves as knowledge resource in coding issue resolution; may provide guidance for daily activities of code auditing staff.
  4. Responds to billing and coding questions from providers, staff and administrators. Maintains tracking system for responses.
  1. Meets and maintains established continuing education, productivity and performance standards.
  1. Optimizes reimbursement, which Wright State Physicians is legally entitled, by applying effective coding strategies. Reviews and applies coding and reimbursement resources in a timely manner to ensure an up-to-date knowledge base.
  2. Assigns and reports codes that are clearly and consistently supported by physician documentation in the health record in accordance with current mandated coding and classification systems.
  1. Consults physicians for clarification/additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.
  2. Verifies patient identity to ensure correct filing of patient information.
  3. Other duties assigned

Education/Certifications:

Associate’s degree in business, health administration, health information management or relevant work experience in lieu of education required.

Certified Professional Coder (CPC), Certified Coding Specialist Physician-based (CCS-P), RHIA, RHIT, Certified Outpatient Coder (COC) preferred. Require Coding Certification within 12 months of employment. Certified Professional Medical Auditor (CPMA) recommended within 2 years of employment.

Experience: Minimum of 3 years of experience. Significant experience in chart abstraction, ICD or CPT coding, charge documentation and/or charge capture resolution. Experience in health care auditing strongly preferred.

Other Requirements:

  1. The employee is expected to protect the privacy of all client/patient information in accordance with Wright State Physicians privacy policies, procedures and practices as required by Federal (and State) law and in accordance with general principles of professionalism as a health care provider.
  2. Maintains the confidentiality of all patient/staff records.
  3. Active participant with teams involved with process improvements.
  1. Must be able to coordinate activities and organize work in an efficient and timely manner. Must be able to evaluate and establish priorities, design and accomplish related goals and objectives, and efficiently coordinate the activities and administrative functions of multiple departments.
  2. Must have ability to work precisely with details, handle stressful situations and maintain a positive work environment.

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