Assists in the performance of Outpatient Services (Physician, Imaging and Diagnostic Center, Ambulatory Surgery Center) coding/billing audits and project reviews.
Demonstrates a general understanding of complex outpatient services coding concepts, (including CPT, ICD-9, HCPCS), and auditing concepts; discusses complex coding and auditing issues with engagement team and client management; keeps informed of professional standards and company/department policies and procedures and effectively applies this knowledge to complex client situations.
The responsibilities of Staff Auditors, in coordinating audits, will vary with the size and complexity of engagements, as well as the experience level of team members assigned.
1. Helps develop the engagement plan and with the guidance of senior team members prepares/modifies detailed programs for tests of controls and substantive procedures.
2. Helps direct the daily progress of fieldwork by informing Managers of engagement status, identifying potential consulting opportunities, and challenging current procedures to improve audit effectiveness and efficiency. Ensures, among other things, that all procedures have been performed properly and the work performed and results are adequately documented, with exceptions and differences appropriately addressed.
3. Understands and the objectives of an engagement and planned other services, and their role in the process.
4. Stays abreast of general industry, regulatory and economic developments and applies their understanding to identify areas of audit significance, assesses the degree of risk and the nature of the errors that could result from coding and billing errors, identifies unusual or unexpected transactions and processes.
5. Executes procedures, such as understanding and evaluating significant sources of information, testing controls, and performing substantive procedures in moderately complex, judgmental and/or specialized areas.
6. Analyzes evidence, reaches conclusions, identifies issues, and proposes strategies for moderately complex issues, as well as makes decisions related to less complex issues related to the audit procedures.
7. Prepares memoranda and other working papers, letters, and correspondences.
8. Utilizes and enhances computer skills including the department's computer-based audit tools.
9. Participates in meetings with the client engagement team and the client.
10. Presents information to others in one-on-one and small group situations, such as verbal presentations to client personnel.
11. Interacts with client personnel and demonstrates a commitment to continually improve our client's satisfaction.
12. Provides guidance to assist Staff in reaching their full potential (e.g., willingly addresses questions, contributes constructive on-the-job feedback and training).
13. Fosters teamwork by maintaining cooperative relationships with the client engagement team, contributing to a work environment that leads to high morale, productivity, and open communications, facilitating the resolution of conflicts, sharing information, and accepting and providing constructive feedback.
14. Maintains an education program to continually develop technical coding, HIM, auditing and management skills consistent with the department's professional development requirements.
15. Assists with other administrative matters (e.g., process improvement team initiatives, recruiting efforts, special projects) when opportunities are presented.
- One or more years of relevant experience is required
- Other Preferred Experience: Outpatient Services (Physician, Diagnostic Imaging, or Ambulatory Surgery) Coding
PHYSICAL DEMANDS/WORKING CONDITIONS
- Certified as a RHIA, RHIT or CPC required
- Physician, Radiation Oncology, ASC or Diagnostic Imaging Coding Experience
- Chargemaster, claims processing and coding quality monitoring experience helpful
- Strong communication skills (oral and written)
- Proficient with spreadsheet and word processing software
- Ability to travel up to 35%
- Ability to work with deadlines and related time pressure
HCA Inc - 23 months ago
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