This position performs concurrent review audits and post-discharge audits for meeting requirements for the Centers for Medicare & Medicaid Services’ (CMS programs and medical record/financially based audits for acute, ambulatory surgery, observation, and rehabilitation inpatients and outpatients. Has accountability for daily management, auditing, data entry, monitoring, tracking, and communication of audit and appeal findings and activities. Provides data, analysis, and reports for internal and external reporting. Assures the organization responds within designated timeframes to requests for medical records and for various levels of government audit and appeals. Monitors the CMS and MAC websites for updates, training events, review and appeal status responses and distributes information as appropriate to internal leadership. Assists with updating of HCPCS/CPT codes and revenue codes for the chargemaster.
The ideal applicant will possess the following:
- Minimum three years of Doing Medicare hospital inpatient and outpatient billing.
- Proficient in use of CMS and MAC websites and portals
- Proficient and accurate in CPT/HCPCS coding for hospitals
- Proficient and accurate in typing and data entry
- Familiarity with electronic medical record documents and printing of same preferred
- Strong organizational skills with a high level of accuracy and attention to detail.
- Ability to synthesize information and concisely communicate verbally and in writing, findings and trend analyses.
- Strong presentation skills with the ability to feel comfortable in presenting/defending audit logic to key stakeholders Including physicians, clinicians, and non-clinical staff
- Experience working with cross-functional departments to research and resolve issues. Proficient in use of Microsoft Word and Excel.