Compliance Facility Coding and Billing Auditor Department: CNE-COMPLIANCE
Operating Unit Care New England
Location: Providence, RI
Job ID: 19180
Job Status: Full Time
Shift: Days
Schedule: Other
*This position will be a hybrid schedule.* Job Summary: Provides support and guidance to providers, support staff, and management in facility-based settings by conducting assigned outpatient and inpatient facility coding and billing compliance audits and education for risk areas identified through analysis of internal and external data. Ensures all documentation, coding, and billing complies with federal and state regulations, private payor health care program requirements as well as the Care New England Compliance Services' policies. Responsible for implementing training programs to assist in Care New England's goal of achieving an effective compliance program.
Duties and Responsibilities: Must consistently demonstrate comprehensive knowledge of outpatient and inpatient facility billing and coding concepts including but not limited to CPT, ICD-10-CM, and HCPCS Level II guidelines, National Correct Coding Initiative (NCCI), National and Local Coverage Determinations (NCDs, LCDs), MS-DRG and APC assignment, Hospital Outpatient Prospective Payment System (OPPS), and Inpatient Prospective Payment System (IPPS).
Audit outpatient and inpatient facility medical records to ensure correct coding and billing. Identify opportunities and implement education related to documentation, coding, and billing for providers, coders, and clinical support staff.
Be consistently available as a subject matter expert for documentation, coding, billing, and other general compliance questions from Care New England providers and workforce teammates.
Requirements: Associate degree in Business Management or Health Care Management or a minimum of 3 years' experience in acute hospital-based inpatient or outpatient coding, with a strong emphasis on revenue integrity and/or HIM coding. Bachelor's degree preferred.
Experience in revenue integrity and HIM coding and auditing. Multi-specialty coding experience for a medium to large health system.
High-level knowledge of medical terminology, anatomy, and pathophysiology. Comprehensive understanding of the proper application of ICD-10-CM/PCS, CPT, and HCPCS Level II codes, MS-DRGs, APCs, and revenue codes. Excellent verbal and written communication skills.
Proficient with Epic and Cerner electronic medical records. Proficient skill level with MDaudit or other auditing software. Proficient skill level with MS Office Suite products such as Word, Excel, and PowerPoint.
Preferred Skills: In addition to the above requirements, experience auditing revenue integrity and HIM coding.
Preferred Certification(s): AAPC: Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Professional Medical Auditor (CPMA), Certified Documentation Expert Outpatient (CDEO), Certified Documentation Expert Inpatient (CDEI). or AHIMA: Clinical Documentation Integrity Practitioner (CDIP).
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.
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