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The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
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Familiarity with CPT, HCPCS, ICD-10 coding, revenue codes, and hospital billing/claims processing. Five or more years of experience in revenue/accounts receivable financial analysis, claims or billing analysis, decision support, or economics in a healthcare setting.
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Description The Coding Auditor demonstrates expertise in coding and billing compliance while performing audits to determine billing integrity of professional and facility/technical fees including detection and correction of documentation, coding and billing errors and/or medical necessity of services billed.
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Knowledge of ICD-10 CPT/ HCPCS coding conventions and reimbursement rules for Medical Necessity, claims denial, bundling issues and charge capture. Two years of experience in the health care industry with at least one year experience working in the following healthcare settings: billing/coding, revenue cycle, or charge capture.
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Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's or Associate's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field.
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Implements, monitors, and improves effective reimbursement procedures, including CPT and ICD-10 coding, in compliance with established third party billing regulations, federal, state, commercial.
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Ensures accurate, timely and appropriate assignment of ICD-10, CPT/HCPCS codes and modifiers for the purpose of billing and compliance with regulatory and payer guidelines. Completes billing for Ryan White services.
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Establishes and maintains understanding of billing and coding regulations, including CPT, ICD, HCPCS, and third-party billing to ensure compliance as well as maintaining fiscal viability for the organization.
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Knowledge of clinical operations, billing, and coding. Experience with net revenue, Crowe revenue analytics tool, and provider enrollment. Responsible for determining contractual and bad debt reserve estimates using the Crowe RCA tool and our accounts receivable model.
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Perform quarterly analysis of FTEs for GME/IME reporting. Hospital Net Revenue Analyst. Collaborate closely with budget, contract management, revenue cycle, operations, and decision support to resolve net revenue issues.
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Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.
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Experience with clinical data transport standards (e.g., FHIR), content standards (e.g., CD, HL7), and terminology standards (e.g., SNOMED, LOINC, ICD-10, CPT, etc.) Experience in health care revenue cycle, payment integrity, billing, coding, and/or reimbursement highly, desirable.
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Working knowledge of CPT-4, ICD-9, HCPCS coding methodologies; Understanding of billing and auditing terms (i.e. HMO/PP/EOB, Stop Loss, etc.) ; Working knowledge of CPT-4, ICD-9, HCPCS coding methodologies; Understanding of billing and auditing terms (i.e. HMO/PP/EOB, Stop Loss, etc.
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A working knowledge of Medical terminology, CPT codes, ICD-10 codes, patient registration, charge entry functions or other billing related experience is preferred. Management of front office operations including scheduling, patient registration and proper billing of insurance plans.
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Interacts directly with EPIC Auth/Cert, Registration and Referral Shell, entering data accurately to coordinate all elements required for payment of services rendered, which includes, but is not limited to, appropriate CPT Procedure and Diagnosis codes, rendering Physician(s), level of care, and facility, i.e., across entities (BWH, BWFH, FXB, etc.
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