Clinical Auditor-IBR

Clinical Auditor-IBR At reputed company , we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive  to bend the cost curve in healthcare for reputed company. Our dedication to service excellence extends to reputed company our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and reputed company each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward !!! JOB SUMMARY This role provides analysis of the highest dollar and most reputed company claims by applying research, coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will reputed company itemized reputed company reviews to identify billing abnormalities, unbundling, questionable billing practices and improper coding combinations from a clinical and coding perspective and documents denial reasoning or erroneous activity. COMPENSATION The salary range for this position is $75-80k annually .  Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity.  This position is also eligible for health insurance, 401 k and bonus opportunity. JOB ROLES AND RESPONSIBILITIES 1. Review and analyze reputed company inpatient and outpatient charges of various reputed company centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as unbundled items and/or inappropriate charges. 2. Documents audit results and updates systems accordingly. Assist management in the daily operations and processes reputed company the department. 3. Identify opportunities for recovery and avoidance. Researches opportunities to reputed company control overpayments and presents reputed company to management. 4. Drive successful coding operations through the application of learned, certified knowledge in addition to reputed company professional development and ongoing coding research. 5. Provide general support to clinical team members, serving as a resource and subject matter expert (SME). 6. Monitors turnaround times for multiple applications and provides suggestions for process efficiencies. 7. Uses independent decision making skills to review claims after business hours to meet deadlines. 8. Apply national coding standards and regulations to claims billed. 9. Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed. 10. Monitor, research, and summarize trends, coding practices, and regulatory changes. 11. Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed. 12. Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner. 13. Partner with management to drive department goals and objectives 14. Collaborate, coordinate, and communicate across disciplines and departments. 15. Ensure compliance with HIPAA regulations and requirements. 16. Demonstrate Company's Core Competencies and values held reputed company. 17. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role. 18. The position responsibilities outlined above are in no way to be construed as reputed company encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary. JOB SCOPE This position works independently with minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and reputed company. More reputed company issues are referred to higher levels. The incumbent follows established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details reputed company performing reputed company aspects of the job. JOB REQUIREMENTS (Education, Experience, and Training)

• Completion of educational curriculum required of medical license or coding certification held, with Bachelor's Degree preferred; and at least 5 years of coding experience.
• Minimum 5 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, reputed company codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes.
• Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria, and applicable industry standards.
• Knowledge of commonly used medical data resources.
• Auditing and health information management experience in a healthcare setting preferred.
• Experience with facility contract interpretation.
• Experience and proficiency using MS Office Suites: reputed company, Outlook, and PowerPoint.
• Excellent communication (written, verbal, and listening), interpersonal, organizational, time-management, analytical, problem-solving, troubleshooting, and customer service skills.
• Ability to reputed company educational materials and job aids pertaining to coding and claims.
• Ability to work evening or weekend hours as needed to meet deadlines.
• Ability to handle multiple tasks in a fast-paced environment.
• Ability to meet individual and team goals, deadlines, and work standards.
• Ability to apply independent judgment and determine appropriate course of action.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss results with providers.
• Ability to reputed company, teach, mentor others, and facilitate a learning environment.

Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.

• BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with reputed company competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs.  Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.   Your benefits will include:

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• Paid Parental Leave
• 401(k) + match
• Employee Stock Purchase Plan
• Generous Paid Time Off – accrued based on years of service
• WA Candidates: the accrual reputed company is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
• 10 paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program

Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits .

• EEO STATEMENT

reputed company is an Equal Opportunity Employer and complies with reputed company applicable laws and regulations.  Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national reputed company, disability or protected veteran status.  If you would like more information on your EEO rights under the law, please  click here .   APPLICATION DEADLINE We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. #LI-KB1 Apply tot his job Apply To this Job