Responsibilities SCOPE: Under minimal supervision performs comprehensive audits for all assigned surgeons, including gynecologic, thoracic, and colo-rectal. Verifies critical element documentation and pathway exception documentation in compliance with Federal and State regulations as well as payor guidelines. Provides effective educational feedback to physicians on findings from audits, updates, and provides general training on documentation best practices. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES:- Performs EMR chart audits for surgeons in accordance with USON requirements to ensure medical records are commensurate with captured charges and billing.
- Works directly with providers to train and advise on supporting documentation for optimal reimbursement.
- Prepares reports of findings that details discrepancies and summarizes opportunities for improvement.
- Identifies coding and documentation trends that could be perceived as non-compliant with local guidelines.
- Recommends procedural improvements and training opportunities to management. Provides written audit reports to supervisor for review and approval.
- Reviews approved audit findings with physicians (individually and in a group setting) to discuss recommendations and improvement opportunities.
- Collaborates with Health Information Management (HIM), CDI, and billing teams to resolve documentation and coding issues.
- Maintains the confidentiality of medical information contained in each record.
- Completes other reasonably related duties as assigned.
SALARY RANGE:$85,000 - $105,000 annually
Qualifications MINIMUM QUALIFICATIONS:- High School diploma or GED; Associate's or Bachelor's degree in Health Information Management or related healthcare field preferred.
- 7+ years of billing, coding, and medical records experience.
- 1+ years of auditor/educator experience required.
- Surgical experience strongly preferred.
- CPC certification is highly desired.
- Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits.
- Must possess a strong knowledge of current versions of ICD, CPT and HCPCS.
COMPETENCIES:- Strong math skills and attention to detail;
- Excellent oral and written communication skills;
- Excellent organizational and follow-up skills;
- Ability to work independently;
- Ability to independently research issues and apply laws & standards.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employment site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. The employee frequently is required to use hands to finger, handle, or feel and occasionally required to reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office, clinical or classroom environment and requires significant interaction with corporate and network staff. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to other USON buildings.
