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Medical Auditor
Physician’s East
Location: Greenville, Hybrid
Work Setting: Physician Office
Job Function: Auditor
Job Type: Full-Time
Introduction
About us
We are looking for an exceptional Medical Auditor to join our family!
Physicians East, PA is a multi-specialty, multi-campus group based out of Greenville, NC offering a wide range of specialties. In addition to primary care the practice offers pulmonary and critical care medicine, rheumatology, dermatology, oncology, endocrinology, cardiology, obstetrics and gynecology, gastroenterology, surgery, urology, and urgent care. Our 102 providers and over 600 employees provide services for thousands of patients in a 29-county region. Our specialists are on staff at ECU Health, a 900+ bed, level one trauma center and the primary teaching hospital for the East Carolina University Brody School of Medicine (ECU-BSOM).
About the role
We are looking for an employee that can work in a fast-paced remote/onsite office setting to conduct in-house audits, provider education, and provide coding related support to expedite the billing process. Additionally, proactively appeals, and assists with rebilling of claims addressing identified errors.
Typical Working Conditions:
Normal office and/or remote office environment
Job Description
Reviews patients’ medical records to ensure coding levels and charting meets standards and regulations
Capable of performing retro audits on patients’ account to ensure documentation supported the level of Evaluation and Management charged
Completes analysis, charts, and spreadsheets to present outcomes to management and physicians
Educates physicians and employees on compliance audit findings by specialty after routine audits or when problems are identified
Responsible for being up-to-date and knowledgeable of coding process and diagnostic procedures as well as carrier specific policies, guidelines, and updates
Research contract allowable to ensure proper payment as well as remaining current about federal and state legislative changes that affect outcomes
Share information as necessary with the Coding & Insurance departments
Stay informed of updates on payer websites
Communicate with Coding and Insurance Supervisors regarding denial trends, problematic denials, and reimbursement issues
Inform Regulatory Services Manager of CPT codes that are routinely not paid, repetitive noncovered diagnoses, or codes not paying according to contractual fee schedules
Reports all identified compliance audit issues to Regulatory Services Manager
Assist Coding and Insurance departments with third party payer coding rules and regulation questions
Provide coding related support to the Coding and Insurance departments for follow-up to expedite appeals and rebilling of claims. This will include researching and correcting claims to validate denial adjustments
Communicates closely with the Insurance Department Medicare Team to ensure that secondary claims are not held up due to coding issues
Provide other assistance to the Coding or Insurance Department as directed by the Regulatory Services Manager
Maintains patient confidentiality
Ability to work independently and proficiently in a remote office environment
Attends meetings when required (onsite/remote)
Required Qualifications
Associates degree or Bachelors degree in Health Information Management with RHIT/RHIA certification and 3-5 years of multi-specialty ICD-10 and CPT experience, or
Bachelor’s degree in health care related field with CPC/CCS-P/CPMA certification and 2-4 years of direct ICD-10 and CPT experience, or
CPC/CCS-P/CPMA certification with 4-6 years of multi-specialty ICD-10 and CPT experience
Preferred Qualifications
RHIT/RHIA certification and 3-5 years of multi-specialty ICD-10 and CPT experience and CPMA certification
Education Qualifications
Associates degree or Bachelors degree in Health Information Management with RHIT/RHIA certification and 3-5 years of multi-specialty ICD-10 and CPT experience, or
Bachelor’s degree in health care related field with CPC/CCS-P/CPMA certification and 2-4 years of direct ICD-10 and CPT experience, or
CPC/CCS-P/CPMA certification with 4-6 years of multi-specialty ICD-10 and CPT experience
Compensation/Benefits
Some of the outstanding benefits you will enjoy at Physicians East!
- Comprehensive Medical and Prescription Drug Plan
- Reduced co-pays when utilizing Physicians East Medical Providers!
- Convenient onsite employee pharmacy that offers reduced co-pays!
- Dental insurance
- Vision insurance
- Critical illness, and other supplemental insurance plans available with payroll deduction!
- Employee assistance program at no cost to employee and covered dependents!
- Life insurance provided at no cost to the employee with options to purchase additional protection for you and your family!
- 401(k) with generous company matching contributions!
- Profit Sharing Program!
- Flex Spending program!
- Company Paid Short Term Disability Insurance*
- Company Paid Long Term Disability Insurance
- Generous PTO accrual that starts on your first day!
- 8 paid holidays in addition to accrued PTO!
- Convenient parking onsite and close to where you work!
- Employee Discounts Programs to save you money!
- Banking and Mortgage discount programs to help you with home ownership!
Instructions for Resume Submission
Please upload resume to:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e7a83d37-7677-472d-bf97-7815a40985f6&ccId=19000101_000001&lang=en_US&jobId=465064
Posted: May 4, 2023 at 11:14 AM
Post ID: 78501