Pro Fee Audit Educator

1 month ago

Linthicum, United States University of Maryland Medical System Full time
Job DescriptionJob DescriptionCompany Description

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

Job Description

Under limited supervision, determines the adequacy of medical records documentation, coding and billing for all providers across all clinical specialties.  Collaborates with clinical operations, CBO and the Compliance Office.  Provides corresponding training and support to providers, professional fee billing staff, clinic staff, administrators, and other personnel on third party payer documentation and billing requirements. Develops coding documentation materials to be used as training tools. Assists in responding to inquiries from providers and staff. Assists in preparing periodic coding updates materials for providers and staff.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification.  These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

  • Conducts independent reviews/audits on the adequacy of medical record documentation to support the codes selected by providers or by billing office coders.
  • Analyzes documentation or coding patterns by a provider, division or department that poses a compliance risk and recommended solutions to address the problem(s).
  • Provides feedback to providers on the results of their medical record documentation reviews and gives targeted training as needed, either individually or to groups.
  • Assists in the development of medical record documentation standards and requirements related to clinical services billing. Develops training and educational materials to address documentation and coding deficiencies and educate staff and providers on new requirements.
  • Conducts concurrent coding reviews for coding staff, and provides timely feedback to the Director.
  • Conduct audits of provider documentation on an ad-hoc basis as requested by the Director.
Qualifications

Education and Experience

  • High school diploma required
  • CPC coding certification is required.  CCS, CCS-P certifications preferred but not required. 
  • CPMA certification preferred.
  • Five (5) years of coding experience and two (2) years of auditing/billing compliance experience required. 

Knowledge, Skills and Abilities

  •  
  • Maintains current knowledge of CPT, ICD-10 and HCPCS coding and modifiers for appropriate reporting of patient services.
  • Demonstrated knowledge of MS Office software applications such as Microsoft Excel and Microsoft Word is required.
  • Ability to maintain a culture of excellent customer service, open and friendly staff relations with all levels of staff.
  • Effective verbal and written communication and listening skills.


Additional Information

All your information will be kept confidential according to EEO guidelines.

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