Medical Oncology Auditor
4 weeks ago
Under the general supervision of the State Reimbursement Manager, the Medical Oncology Auditor performs comprehensive medical record chart and coding audits for medical and radiation oncology physicians, adhering to The US Oncology Network's established guidelines.
Responsibilities:- Conducts paper and EMR chart audits for medical oncology physicians/providers to ensure medical records align with captured charges and billing.
- Utilizes various reports, including AMA guidelines, Medicare LCDs, commercial payor billing guidelines, coding manuals, and ASTRO/ACR guidelines, to accomplish tasks.
- Prepares a spreadsheet of findings detailing discrepancies and summarizes metrics.
- Identifies trends that may indicate non-compliance with local and federal regulatory guidelines.
- Recommends procedural improvements and training opportunities to management.
- Provides written audit reports to supervisors for review and approval.
- Reviews approved audit findings with physicians and mid-level providers to discuss recommendations and improvement opportunities.
- Maintains the confidentiality of medical information contained in each record.
- Assists with other audits, such as hospital visits, consultations, and others as assigned.
- High School diploma/GED required.
- CPC certification required.
- Nine (9) years of billing, coding, and medical records experience required.
- Completion of required The US Oncology Network's Reimbursement tutorials as required by the Compliance Department required.
- Internal Billing and Coding Integrity Program certification (BCS-M) in Medical Oncology and (BCIP) in Radiation Oncology.
- Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits.
- Must possess a strong knowledge of current versions of ICD9, CPT4, and HCPCS.
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment.
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