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Reimbursement Auditor
Franciscan Missionaries of Our Lady Health System. Perform audits of Charge Master-driven and HIM-assigned codes and medical record documentation against itemized charges and facility-assigned codes on government and non-government accounts .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical coding and billing practices, with a strong focus on compliance with government regulations and effective training of hospital staff. Proficient in data analysis and process improvement initiatives to enhance revenue cycle management.
Highest-signal resume keywords
ICD-9-CM KnowledgeCPT-4 Coding Proficiency3M Coding Software ProficiencyRHIT or LPN LicensePayment Review Systems Expertise
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Record AuditingCharge Master AuditsBilling Edit ResolutionData AnalysisCoding ComplianceProcess ImprovementAPC Regulations KnowledgeCPT-4 and HCPCS Level II CodesItemized Charge ReviewRevenue Cycle Management
Soft Skills
Communication SkillsTraining and EducationProblem-SolvingTeam CollaborationAnalytical Thinking
Tools & Technologies
Payment MethodologiesInsurance TermsFederal Register ReviewMedicare BulletinsFiscal Intermediary Transmittals
Certifications & Qualifications
RHIT LicenseLPN License
Industry Keywords
Charge Description MasterBilling PracticesGovernment Program RegulationsMedicaid ComplianceRevenue-Producing Departments
About the role
Key responsibilities & impact- Perform audits of Charge Master-driven and HIM-assigned codes and medical record documentation against itemized charges and facility-assigned codes on government and non-government accounts
- Adjust incorrect items and/or services
- Assist with billing edit resolution and provide coverage guidelines for billable services
- Review the Federal Register, Medicare and Fiscal Intermediary transmittals, bulletins, memorandums, NCD, LCD/LMRP, OCE, and CCI edit management resources
- Communicate current and pending APC and other government program regulations to designated hospital team members
- Provide bi-yearly training to designated hospital staff and education to revenue-producing and ancillary department staff as needed
- Review CMS, Medicare, and Medicaid bulletins and implement internal changes to maintain coding and charge-practice compliance
- Make monthly observations and recommendations to prevent future billing problems and develop process improvement initiatives
- Reduce bill rejections and payment delays related to coding and billing practices
- Prepare reports on process improvement recommendations and systemic claim processing issues
- Perform medical record audits to ensure services are accurately reflected on itemized statements and related documents
- Review focused retrospective claims and records for accuracy and defend facility charging and coding practices during focused audits
- Identify coding and billing problems related to APCs and review outpatient claims for correct CPT-4 and HCPCS Level II codes
- Develop data analyses regarding revenue effects of changes to the Charge Description Master and/or billing practices
- Perform other duties as assigned
Requirements
What you’ll need- 3 years experience
- Associate Degree in Nursing or HIM
- Proficient in payment review systems, payment methodologies and insurance terms
- Ability to synthesize and evaluate data
- In-depth knowledge of ICD-9-CM, HCPCS, CPT-4 nomenclature, codes and guidelines
- Proficiency with 3M coding software
- Current RHIT or LPN License