Clinic Data Audit Specialist

2 weeks ago


Sacramento California, United States CommonSpirit Health Full time
Overview:
Built-in 1973 Dignity Health Methodist Hospital of Sacramento is committed to providing daily excellence in health care for residents of Sacramento’s southern suburbs including the Elk Grove Wilton and Galt communities. Methodist Hospital is home to a 158 acute-care bed facility with 1120 employees 283 medical staff and 29 Emergency Department beds. Methodist Hospital also owns and operates Bruceville Terrace – a 171-bed sub-acute skilled nursing long-term care facility adjacent to the hospital that provides care for the elderly as well as those requiring extended recoveries. Methodist Hospital is home to the Family Medicine Residency Program an accredited and nationally recognized program which provides resident physicians with specialty training in primary care family medicine. Together the hospital and residency program implemented a ground-breaking curriculum addressing the identification treatment and assistance of human trafficking victims and created a one-of-a-kind health clinic for victims the Human Trafficking Medical Home.

Responsibilities:
The incumbent is knowledgeable in billing procedures with a variety of payer sources. Has knowledge in the current ICD and CPT coding in a clinic setting. The incumbent is responsible for performing all required testing audits and verifies accuracy of the documentation to ensure medical necessity for appropriate charges are within the electronic medical record prior to releasing charges. Works closely with the finance accounting & coding departments to ensure claims are populated with correct/proper coding based on Medicare and Medi-Cal billing guidelines. Responsible for updating CDM dictionary. Educates instructs and updates providers regarding the need to accurately document care to support ICD coding and level of billing. Acts as a resource for questions regarding coding/billing. Performs other duties as assigned.

 

 

Qualifications:
Minimum High school diploma (or equivalent) required

One (1) year of experience in a medical environment handling insurance claims required

Knowledge of Medical Terminology; use of CPT, ICD codes and HCPC coding manuals Excellent communication skills, verbal and written

Ability to take instruction and follow established procedures

Ability to exercise independent judgment, common sense, initiative and troubleshoot

Ability to work under pressure in a fast-paced environment, complete tasks in a timely manner, and work without close supervision

Ability to make accurate arithmetic computations and comparisons and use standard alphabetic and numeric keyboards

PreferredCPMA preferred

Working knowledge of Cerner Power Chart preferred

Experience with IDX systems preferred

Strong interpersonal communication skills preferred

Experience presenting to Providers and Coders on a one-on-one and group base preferred



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