Reimbursement Auditor

Job not on LinkedIn

🔥 8 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Franciscan Missionaries of Our Lady Health System

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1911

🏥 Healthcare

🤝 Non-profit

🌍 Social Impact

Healthcare • Non-profit • Social Impact

Franciscan Missionaries of Our Lady Health System is one of the largest healthcare systems in Louisiana, serving over half of the state's population and the largest metropolitan area in Mississippi. This non-profit, Catholic organization offers a comprehensive range of healthcare services through its network of hospitals, clinics, and physicians, focusing on quality patient care, community health, and education. Headquartered in Baton Rouge, Louisiana, the mission of the organization is to provide excellence in health services and to care for the sick across Louisiana and Mississippi.

📋 Description

• 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

• 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