Medical auditor job description

Responsible for working independently on reviews of medical record documentation and corresponding charges and coding to assess compliance with all regulations of federal and state agencies and third party payors. Coordinates monitoring of all coding accuracy and documentation adequacy. Conducts trends analyses to identify patterns and variations in coding and case-mix index. Compares coding and reimbursement profile with national and regional norms to identify variations. Conducts internal investigations of changes in coding practices or reports of other potential problems pertaining to coding. Responsible for auditing and investigating patient inquiries regarding services provided. Responsible for coordinating and scheduling all third party chart audits. Will assist Corporate Compliance in maintaining the hospital's Corporate Compliance Program.
Performance Expectations:
Demonstrates the ability to review the EMR for abnormal results and communicate with the Emergency Room Physician if further treatment is needed. Demonstrates the ability to communicate effectively with patients.
Demonstrates the ability to work under the direction of the ED Manager, to complete various task when needed


Education:
Licensed RN or Bachelor's Degree in Nursing, Health Information Management or health related field required.
Extensive knowledge of CPT and ICD-9 codes required. A working knowledge of medical terminology, patient
care services and medical record chart documentation (inpatient and outpatient) is also required. Must have
extensive knowledge of medical diagnosis, treatment protocol, and current federal and state healthcare rules and
regulations sufficient to verify billing compliance. Proficiency with word processing and spreadsheet programs
on a personal computer required. Experience using the following applications is desirable: Word, Excel, Access,
and ACL. Must have effective written and oral communication skills and be able to work with all levels of
management.


Work Experience
: Three to four years recent experience in clinical operations, medical record auditing, coding, billing, or reimbursement required.


Certification/Licensure
: Required to hold a current license to practice professional nursing in the state of Mississippi. Professional certification such as CCS, ART, or RRA preferred

Medical Auditing experience required (2 years)

Physical Requirements and Working Conditions:

• Sedentary work, requiring lifting to 10lbs

• Repetitive motion associated with operating a computer and other office equipment

• Inside, climate-controlled working conditions

Granger Medical Clinic offers competitive wages, potential for quarterly bonuses, and excellent benefits. Benefits include:

• Vision
• Dental
• Medical
• Sick leave
• Paid Time Off
• Life Insurance
• Paid maternity leave
• Tuition Reimbursement
• Short- and long-term disability
• Employee Assistance Program (EAP)
• Health Savings and Flexible Spending Accounts
• 401(k) with a Company Match, Profit Share, and Safe Harbor contributions

Granger Medical Clinic provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Granger Medical Clinic complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regards to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability status, genetic information and testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law.

Job Posted by ApplicantPro

As an Authorization Auditor, you are responsible for activities associated with auditing on-shore and off-shore Central Authorization Team (CAT) employees.
What you will bring to be successful:

* Healthcare billing or accounts receivable (A/R) experience.
* Experience working healthcare insurance authorizations, payor websites, clearinghouse applications, EMR, ICD-10 and CPT coding.
* Auditing experience.

ATI offers an attractive total compensation package with best in class, customizable benefits plan including:

* Medical, Dental,Vision Insurance
* An exceptional 401k plan
* At ATI, we care about your work life balance. We want you to enjoy your time away from work by utilizing our competitive PTO plan
* Being a healthcare company, we understand what it means to feel safe and healthy. ATI provides a bank of sick time to use for emergencies
* Paid holidays
* And the ability to add in and customize benefits like our popular pet insurance

This is an opportunity to join the best Physical Therapy Company in the world while learning great skills that will help your personal and professional growth. We are the largest physical therapy company under one brand name in the U.S., but also pride ourselves on our small-practice, family-like atmosphere.

Responsibilities

* Complete research through interviewing payor representatives, researching procedures on payor websites, and testing procedures to ensure most efficient process is outlined in the SOPs.
* Demonstrate a strong knowledge of authorizations including Workers Compensation, Auto, Personal Injury, Medicare, Medicaid, and local HMO/PPOs.
* Handle a large volume of communication inbound/outbound calls and written correspondence within department standards for account resolution.
* Take appropriate action to resolve patient accounts including telephone, email, written correspondence, websites, and clearinghouse tools.
* Evaluate if escalations are due to vendor/onshore teams' deviations from SOPs or if payor behavior has changes and communicate the remedial actions that are needed.
* Meet and maintain monthly productivity standards of quality and quantity.
* Collaborate with department leadership to review and root-cause authorization denials.
* Participate in action plans to resolve root causes.
* Communicate in a manner that results in positive relationships between ATI and customer.
* Provide exemplary customer service to internal and external customers.
* The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned to the employee from time to time, or the scope of the job may change as necessitated by business demands.

Qualifications

Education:

* High School Diploma or equivalent required.

Experience:

* 2 years in healthcare billing or accounts receivable experience required.
* 1 year of auditing experience required.
* Experience with authorizations.
* Experience working with offshore vendors.
* Experience working with payor websites, clearinghouse applications
* EMR, ICD-10 and CPT coding.

Knowledge Skills and Abilities:

* Ability to maintain friendly and appropriate communication in any situation.
* Knowledge of payor websites, clearinghouse applications, and patient accounting systems.
* Proficiency in Microsoft Office.
* Attention to detail.
* Ability to understand ATI standard operating procedures, contracts, billing, and cash collected.
* Ability to work in fast-paced, paperless environment with appropriate multi-tasking.
* Ability to problem-solve.
* Ability to work independently.