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Coding Auditor-Revenue Management (RN)

New York NY

Post Date: 01/19/2018 Job ID: 4551 Department: Financial Services

Title: Coding Auditor-Revenue Management (RN)

Location: Manhattan, NY 10001

Industry: Healthcare

Occupational Category: Finance

Hours: Full-time

Description: Hiring a Coding Auditor-Revenue Management (RN) for a top academic medical center. The Coding Auditor-Revenue Management (RN) will perform detailed audits of medical cases to ensure accuracy of assigned charge codes, prices, availability of documented medical records, medical accounts and compare the cases with the itemized bill and overall procedures. The Coding Auditor-Revenue Management (RN) reviews and audits current and retro accounts, and reports audit outcomes regarding charge errors, percentage of savings or losses for facility, data processing errors, performance of hospital charging system, documentation within medical record and itemized bill. Works with Process Improvement Analyst in identification of process improvement related to coding and charging of hospital services.

Responsibilities:

  • Performs audits of coding and medical record documentation against the itemized charges and UB-92/UB-04 codes assigned on government and non-government accounts to ensure all services provided are accurately reflected on the itemized statement.
  • Defends facility charging and coding practices during focused audits.
  • Follows up with physicians/departments to better understand the procedures and identify whether any procedures have not been reported/priced.
  • Identifies opportunities to assign a more appropriate code that results in a higher return.
  • Reviews individual charge procedures, identifies correct service codes on supplies and services
  • Identifies compliances risks and financial opportunities based on chart reviews.
  • Reviews claims to ensure correct codes for patient accounts.
  • Decreases bill rejections and payment delays due to coding and billing practices
  • Responds to requested and/or mandated charge master changes from the CDM Analyst.
  • Submits recommendations for internal changes to keep coding and charge practices compliant

Educational Requirements:

  • Bachelor’s Degree in Nursing or other health related field
  • Licensed Registered Nurse
  • CCS or CPC preferred

Experience Requirements:

  • Minimum of two years of procedure-based outpatient coding

Desired Skills:

  • Spreadsheet, graphics, and database software applications
  • Proficiency in payment review systems, hospital information systems, clinical record information systems, and some coding methodologies
  • Quantitative, analytical, interpersonal and communication skills
  • Understanding of medical records, hospital bills, insurance terms, payment methodologies and the charge master
  • Knowledge of regulatory agencies’ requirements (JCAHO, CMS & Medicaid)
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