Senior Auditor, Billing Compliance

Senior Auditor, Billing Compliance

Position Highlights:

• Position: Senior Auditor, Billing Compliance

• Location: Hybrid (Evanston, IL and remote)

• Full Time/Part Time: Full Time

• Hours: Monday-Friday, 8:00am-4:30pm

• Travel: travel to other locations in the health system may be required

What you will do:

• Conduct comprehensive retrospective and/or prospective coding/billing/documentation audits for multi-specialties within the medical group and/or facility departments, as assigned.

• Analyze source documents (including but not limited to, progress notes, operative reports, pathology reports, etc) and associated billing documentation (such as encounter forms, EOBs, Epic billing data and related documents) for coding and billing accuracy.

• Audit ICD-10-CM, CPT/HCPCS or ICD-10-PCS codes for appropriateness compared to medical record documentation by applying appropriate corporate policy, state/federal regulation, coding rules, commercial payer guidelines, and/or Medicare/Medicaid guidelines (e.g. NCDs, LCDs, Medicare Manuals, and DRG/APC/RBRVS/other relevant Prospective Payment System billing rules).

• Conduct internal Compliance investigations in response to external concerns. These investigations can involve high-risk scenarios that require immediate and extensive review while maintaining a strict level of confidentiality.

• Identify trends or patterns of questionable coding and billing practices for the System and reports issues to Manager.

• Communicate incidental findings identified in audits for potential future investigation.

• Document relevant findings for all audits and investigations conducted, including pertinent details from interviews, claim audits, control assessment, root cause analysis, and corrective action plans.

• Calculate reimbursement impact and statistical error rates based on findings in audits and investigations that may later result in larger overpayment calculations. Overpayment calculations may sometimes require data mining and testing skills to ensure report accuracy and using extrapolation methodologies.

• Facilitate communication of audit and investigational activities between internal/external customers.

• Keep current on topics related to coding, billing, and documentation requirements, including, but not limited to ICD-10-CM/PCS and CPT/HCPCS annual code changes and Medicare regulatory updates.

• Work on special projects related to Billing Compliance as assigned by Manager

What you will need:

• Education: Bachelor's degree, required

• Certification: RHIA, RHIT, or nurse with a coding certification (CCS, CPC), required.

• Experience:

  • 3+ years of work experience with a focus on regulatory billing compliance and/or facility/professional revenue cycle experience

  • Experience with analyzing and/or auditing Revenue Cycle functions; including, but not limited to, ICD-10, CPT, and HCPCS coding accuracy, Medicare policy requirements, and any other operational workflows affecting billing accuracy for hospital or physician claims.

  • Experience with compliance auditing, facility and physician coding/billing practices, PPS systems of payment (e.g. DRG, APC, APL, HHRG, CMG) and Medicare provider-based rules preferred.

  • Related experience in physician and hospital inpatient/outpatient medical billing, reimbursement, chart review, coding compliance, medical office or patient accounts, rehabilitation, clinical trials coding/documentation requirements, home health/hospice, practice management and physician revenue cycle and strategy consulting is a plus.

• Unique or Preferred Skills:

  • Skilled at medical coding and related research & analysis with the ability to stay up to date on regulatory and coding changes and applying those rule changes into audit and investigation projects.

  • Must have the ability to interpret a variety of clinical documents and information, CMS policies and procedures, third party payer guidelines and government regulations and effectively communicate technical coding information to a variety of non-coder staff.

Benefits:

• Career Pathways to Promote Professional Growth and Development

• Various Medical, Dental, Pet and Vision options

• Tuition Reimbursement

• Free Parking

• Wellness Program Savings Plan

• Health Savings Account Options

• Retirement Options with Company Match

• Paid Time Off and Holiday Pay

• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.