Internal Auditor
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Job Description
Responsible for auditing coding and billing accuracy and identifying trends/problems; makes recommendations to improve procedures; provides education to clinical and administrative staff; coordinates with coding staff, utilization review staff, department managers, physicians and patient financial services staff to validate and ensure proper documentation of medical necessity, services, charges, strengthen controls, reduce denials, and facilitate resolution of other identified issues. Must have CPC or equivalent. Requirement: CPC or equivalent, HS Diploma Hours: Remote, 8am-4:30pm, Monday-Friday
Responsibilities
Coordinates assistance from Medical Records Management and other departments to defend charges against outside third party auditor representatives., Develops action plans to support goals and objectives as required by Audit Supervisor & Enterprise Risk Management Admin Director, Enforces Third Party Audit policy; preforms preaudit of final billed patient accounts for which outside audits have been requested and policy requirements satisfactorily achieved., Formulates procedures and prepares reference material to be used for orienting, training and educating clinical and office/administrative staff on coding and billing compliance., Identifies possible trends, which require additional focused study, or critical issues, which should be addressed immediately, Investigates patient billing complaints with an emphasis on medical record documentation for overcharges and undercharges., Notifies other departments of impact of proposed changes before they occur and assist in implementing changes when applicable., Other duties as assigned., Performs revenue integrity audits and prepares work papers, which satisfactorily document audit work performed, conclusions reached and recommendations for improvement. Proposes recommendations which are practical, cost effective and/or reduce costs and sensitive to patient satisfaction. , Provides consultation to Medical Staff, developing and maintaining a professional relationship to facilitate the process., Reviews medical record and other documents to verify that orders and documentation are present to justify charges billed to payer. Identifies issues of quality of care, length of stay and appropriateness of care., Verify RHIT certification renewal., Works cooperatively with Patient Financial Services and Medical Records Management staff and with other areas to facilitate communication, problem solving, and change.
Requirements
High School (Required)Certified Professional Coder-A - Sarah Bush Lincoln, Certified Professional Coder - Sarah Bush Lincoln, CPC-H - Certified Professional Coder-Hospital - American Academy of Professional Coders, LPN - Licensed Practical Nurse - Illinois Department of Financial and Professional Regulation
Compensation
Estimated Compensation Range $26.35 - $40.84Pay based on experience