Revenue Cycle Management Coding Auditor

The Opioid Epidemic is a public health crisis with a highly effective but underutilized clinical intervention - millions of Americans are physically dependent on Opioids but only 10% of those likely to have OUD actually access treatment. Bicycle Health addresses this gap by maximizing accessibility, affordability, and overall quality of care by enabling highly qualified clinicians to reach patients broadly and efficiently through our online platform.

The Revenue Cycle Management Auditor audits medical record documentation to identify under coded and up coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues. Interacts with providers and management to review and/or implement codes and to update charge documents. Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.

Location:
Remote

Schedule
: 40hrs

Target Pay:
$32.00-$37.00 per hour - Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.

RESPONSIBILITIES:

• Responsible for examining medical records, clinical documentation and claims to verify the accuracy and completeness of assigned codes.
• Responsible for identifying discrepancies, errors and inconsistencies in coding and billing practice. Including the potential of fraud, waste, and abuse (FWA).
• Ensures all federal and state regulations, Medicare and Medicaid rules and other payer guidelines are being followed
• Creates reports on identified errors and trends and recommends process improvements to management
• Collaborates with compliance, billing, clinical and clinical leadership to resolve any coding discrepancies.
• Responsible for maintaining a tracking system for all audits/requests activity throughout all levels of appeals.
• Researches new healthcare related questions as necessary to aid in investigations and stays abreast of current medical coding and billing issues, trends and changes in laws/regulations.
• Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
• Reviewing Chart Records to confirm accurate documentation to decrease audit concerns and documenting findings.
• Assisting our Compliance Officer with coding training documentation to better equip our providers
• Establishing workflows, policies and procedures, software analysis and maintenance and implementation of processes and communication plans for the facility's interactions with third party auditors
• Pre and post payment Medicare, Medicaid and commercial insurance reviews to ensure timely completion or review/audit documentation requests.
• Regular and predictable attendance is required.
• All other duties as assigned.

COMPETENCIES:
Demonstrates Self Awareness

• Reflects on activities and impact on others.
• Proactively seeks feedback without being defensive.
• Is open to criticism and talking about shortcomings.
• Admits mistakes and gains insight from experiences.
• Knows strengths, weaknesses, opportunities, and limits.

Action Oriented

• Readily takes action on challenges, without unnecessary planning.
• Identifies and seizes new opportunities.
• Displays a can-do-attitude in good and bad times.
• Steps up to handle tough issues.

Takes Ownership/Ensures Accountability

• Follows through on commitments and makes sure others do the same.
• Acts with a clear sense of ownership.
• Takes personal responsibility for decisions, actions, and failures.
• Establishes clear responsibilities and processes for monitoring work and measuring results.
• Designs feedback loops into work.

Communicates Effectively

• Is effective in a variety of communication settings: one-on-one, small and large groups, or among diverse styles and position levels.
• Attentively listens to others.
• Adjusts to fit the audience and the message.
• Provides timely and helpful information to others across the organization.
• Encourages the open expression of diverse ideas and opinions.

Nimble Learning

• Learns quickly when facing new situations.
• Experiments to find new solutions.
• Takes on the challenge of unfamiliar tasks.
• Extracts lessons learned from failures and mistakes.

QUALIFICATIONS:

• Requires a AA/AS and minimum of 4 years medical coding/auditing experience, including minimum of 1 year in fraud, waste abuse experience; or any combination of education and experience, which would provide an equivalent background.
• 3 years of provider chart auditing experience
• Extensive ICD-10 and CPT coding experience
• Requires coding certification -CPC, CCS, CPMA, COC OR RHIT certification.
• Ability to read and understand oral and written instructions and follow written protocols.
• Ability to examine documents for accuracy and completeness.
• Ability to provide excellent customer service.
• Skill in presenting information in an organized manner.
• Skill in verbal and written communication.
• Consistent access to a private work environment with high speed internet and professionally appropriate surroundings for frequent video conferencing and a workstation setup conducive to remote work needs.

PHYSICAL REQUIREMENTS:

• Constantly operate a computer and other related peripherals such as a keyboard, mouse, headset etc.
• Must be able to remain in a stationary position a majority of the time working.
• Frequent communication via remote meeting software; softphones or cell phones.
• Predominantly working in the employees home, indoor, office setup.

About Bicycle Health:

Bicycle Health is a telemedicine group that specializes in the evidence-based treatment of individuals with Opioid Use Disorder using buprenorphine. We've grown our clinical staff of medical providers caring for patients, across 32 states, and we employ a large ancillary staff for support with technologic and administrative needs, clinical and behavioral support, and care coordination. Our innovative model has achieved clinical outcomes that exceed expectations for standard-of-care in-person treatment nationally. Our mission is to increase access to high quality, affordable, convenient and confidential Opioid Use Disorder treatment for all.

Bicycle Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or any other basis forbidden under federal, state, or local law.