Works independently performing program, compliance, and risk-based reviews of healthcare-related activities to ensure accuracy of medical record documentation, coding, billing, and policies.
Responsible for written audit summaries that include findings and audit recommendations.
Conducts revenue cycle investigations to determine and mitigate risk through findings, reports, and recommended action plans.
Coordinates, develops, and conducts educational training based on audit outcomes.
Provides education to coders, billers, physicians, and others on documentation requirements and correct coding for inpatient, outpatient, and professional fee services.
Assists Corporate Compliance in maintaining the hospital's Corporate Compliance Program.
Performs comprehensive reviews of health care records for revenue cycle billing compliance, including medical necessity, compliance risk, denials, charge trends, and applied coding guidelines.
Produces audit reports with quantifiable impact, areas for education, and improvement recommendations.
Generates audits using auditing platforms for denials, coding reviews, and other risk-based departmental audits.
Communicates opportunities related to clinical documentation guidelines, service selection, charge capture, timely submission, healthcare data accuracy, and coding principles.
Participates in process improvement, annual risk assessment, work plan development, and enhancement of audit methodologies, workflows, and tools.
Works collaboratively with hospital, surgical, and clinical practices as well as leadership on revenue cycle compliance.
Associate's or technical degree, or equivalent combination of education and related experience required; bachelor's degree preferred.
Five years of experience in healthcare coding for inpatient, outpatient, rural health care, and/or professional fee services required.
Three years of experience in auditing clinic and/or facility revenue cycle preferred.
Required certifications: CCS, CPC, or CCS-P.
Preferred certifications include CPMA, CEMA, RHIT, RHIA, CDE, CEMC, CDIP, or CCDS.
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 month ago