Auditor/Educator II

  • Carolinas Healthcare System
  • Charlotte, NC, USA
  • Feb 09, 2018
Full time Healthcare

Job Description

Location Details: 
Job Summary
Provides coding, billing and compliance support and training to physicians, mid levels, residents, support staff and administration of the Carolinas Healthcare System Physicians Services Group and/or regional network providers; monitors coding and billing activities to verify that activities performed by providers/practices are in compliance with applicable federal and state statutes/regulations, as well as address preventable revenue loss; develops education/training programs, coding tools and resources to help achieve the goal to be consistent, complete and accurate in coding and reimbursement.

Essential Functions
  • Maintains a working knowledge of the ICD-10-CM and CPT/HCPCS coding principles and the AMA/CMS Documentation Guidelines (DGs); keeps current on any changes to payer-specific reimbursement policies; acts as a coding resource to his/her assigned practices, Revenue Cycle Team and the Billing Office, responding to inquiries on a timely basis.
  • Routinely conducts provider chart reviews and performs other reviews, as needed, to understand how a provider selects his/her diagnosis, procedure and Evaluation and Management (E/M) codes and offers advice about the application of the AMA/CMS DGs; provides written reports with review findings to leadership; provides follow-up education based on review findings.
  • Periodically reviews and analyzes denial information from third party payers to understand reasons for denials; coordinates with practice management and the Revenue Cycle Team to address operational issues that are contributing to the denials; reviews denials received from the RAC (Recovery Audit Contractor); writes appeal letters as indicated.
  • Monitors regulatory and reimbursement information to keep informed of relevant changes/updates.
  • Analyzes E/M coding profiles and other comparative data to identify utilization trends and coding patterns that may provide clues on where to focus further analysis and education.
  • Reviews encounter form information at least annually; recommends additions, revisions and deletions to codes and encounter form layout as indicated; coordinates the timing of these reviews to correspond with the ICD-10-CM and CPT/HCPCS code changes that are published.
  • Develops Job Aids, Documentation Templates, that will ensure compliance in capturing identified revenue.
  • Researches, develops and delivers education/training classes and training material
  • Identifies business practices and processes that need investigation and/or intervention.
  • Maintains a working knowledge of the GECB and/or EPIC billing system, GECB TES functionality and recommends/coordinates changes in billing edit rules.
  • Establishes and maintains a positive and professional working relationship with teammates.
  • Assists practice management staff with research on difficult claims and unusual billing situations; performs special demand audits as requested.
Physical Requirements
Ability to sit and concentrate for extended periods of time. Frequent reaching and handling of reports and/or medical records. Local travel to assigned practices required. Ability to work under pressure and meet deadlines.

Educational Experience
HS Diploma or equivalent required. Bachelor�s degree preferred. Healthcare consulting preferred. CPC, CCS-P, RHIT or RHIA credential required. CEMC required or must be obtained within first year of employment. Internal departmental promotions to this position must obtain CEMC within first year following promotion. Knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding classification systems required. Minimum of 5 years coding experience required. Knowledge of medical terminology and anatomy and physiology required. Prior IDX billing system experience preferred. Knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing.
At Carolinas HealthCare System, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.
As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.
Posting Notes: Not Applicable
Carolinas HealthCare System is an EOE/AA Employer