Revenue Integrity Auditor
- - Administration
- NY, USA
- Full Time
Planned Parenthood Mohawk Hudson is a leading health care provider, educator, and advocate, serving nearly 20,000 adults and teens throughout Central and Eastern NY annually. Our dedicated staff provide every person in our community access to comprehensive health care services, education programs, and fearless advocacy they need to be healthy, plan their futures, and achieve their dreams.
PPMH is seeking a committed and enthusiastic Revenue Integrity Auditor who will performs audits, evaluates compliance-related activities and services, resolves charging and coding issues and stays abreast of all changes related to billing/coding compliance. Auditing may include documentation and coding of Evaluation/Management (E/M) services, procedures and midlevel services. Utilizes ICD-10, CPT, HCPCS and other coding references to ensure accurate coding and billing.
Location: Schenectady with travel to Poughkeepsie, New York area. Must be able to travel all locations.
Duties and Responsibilities
• Assists in risk analysis to identify areas with potential for non-compliance with governmental and internal requirements.
• Conducts comprehensive revenue integrity audits. Conducts and/or participates in charge master and other coding reviews.
• Reviews charge information, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities and credit processing are being performed in an accurate and timely manner and is supported by documentation.
• Develops audit scope, objectives, and audit programs or protocols, as appropriate.
• Manages audit programs within established timelines to maintain compliance with internal and external standards and protocols.
• Maintains audit documentation, including, identified issues, individuals involved, corrective actions taken, and improvements implemented.
• Monitors the implementation status of management's corrective action plans in response to identified compliance issues as assigned.
• Makes recommendations that are consistent with regulatory requirements.
• Creates final audit reports for review.
• Assists in the development of relevant policies and procedures.
• Provides education or guidance on medical record documentation guidelines, billing rules and related standards.
• Have knowledge and understanding of organizational policies and procedures, billing and reimbursement requirements, and other regulations that affect operations.
• Maintains appropriate reference material that will facilitate the understanding of and compliance with federal coding/documentation requirements.
• Stays current with developments and best practices within the industry and provides research and advice for billing compliance initiatives.
• Performs other duties as required
• Four (4) year bachelor's degree and minimum three (3) years relevant experience in physician setting, clinic setting, or insurance company with revenue cycle experience.
• OR Two (2) year degree and minimum five (5) years relevant experience in physician setting, clinic setting, or insurance company with revenue cycle experience.
• OR Seven (7)+ years of physician, clinic setting or insurance company with revenue cycle experience.
• RHIT/RHIA, CCS, CMA, CPC, CPC- P, CPC-H or other coding or auditing certification required.
• Knowledge of health care compliance programs and guidance, healthcare reimbursement and third party payer guidelines.
• Knowledge of the various payment systems including APCs/APGs, RBRVS and various managed care and capitated arrangements.
• Experience with electronic health records.
• Strong analytic aptitude.
• Excellent project management skills.
• Independent judgment in investigation and preparation of documents.
• Working knowledge of information systems and technology in healthcare.
• Proficiency in Microsoft Word, Excel and Power Point
• Previous training experience preferred
• Own transportation is required, with a valid driver's license, inspection, registration and adequate insurance
One of our workplace values is "We Tend to the Team" - in that spirit, we offer competitive compensation, full medical/dental benefits, generous FLT accrual, automatic employer 401(k) contribution, employee wellness program, and opportunities for professional development and training with national advocacy experts and leaders.
DIVERSE CANDIDATES ARE ENCOURAGED TO APPLY
Planned Parenthood Mohawk Hudson is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment, and does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law. Planned Parenthood is committed to creating a dynamic work environment that values diversity and inclusion, respect and integrity, customer focus, and innovation.