We have an exciting opportunity to join our team as a Coding Auditor-Revenue Management.
Position Summary: In this role, the successful candidate performs detailed audits of medical cases to ensure accuracy of assigned charge codes, prices, availability of documented medical records, medical accounts and compares the cases with the itemized bill and overall procedures. The Code-Based Charge Auditor reviews and audits current and retro accounts, and reports audit outcomes regarding charge errors, percentage of savings or losses for the facility, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill. Works cooperatively with the Process Improvement Analyst in the identification of process improvement initiatives related to the coding and charging of hospital services.
Performs audits of coding and medical record documentation against the itemized charges and UB-92/UB-04 codes assigned on government and non-government accounts to ensure all services provided are accurately reflected on the itemized statement.
Reviews all related documents, and identifies clerical, interpretation and record errors and adjusts incorrect items and/or services.
Defends facility charging and coding practices during focused audits.
Follows up with Physicians/departments to better understand the procedures and identify if any procedures have not been reported/priced; Identify opportunities to assign a more appropriate code that results in a higher return to the Health System.
Reviews individual charge procedures related to each case, identifies correct service codes on supplies and/or services and makes corrections as needed.Identifies compliances risks and financial opportunities based on chart reviews.
Creates/updates and/or maintains charge protocol manuals for each service area reviewed. Seeks information necessary to accurately complete all aspects of the job requirements.
Documents results of all special project work and provides recommendations for revenue managing opportunities and process improvement initiatives relating to special projects.
Makes ongoing observations and recommendations to prevent future billing problems and prepares reports as required by management regarding process improvement recommendations/initiatives and systemic claim processing issues.
Participates in and/or leads inter-departmental process improvement initiatives.
Liaises with hospital departments to communicate observations, seek clarification and makes recommendations for charge capture improvement.
Reviews claims to ensure correct codes for patients accounts. Utilizes correct coding initiative conventions and follow established policies and guidelines to determine accurate code selection based upon documentation in the medical record. Decreases bill rejections and payment delays due to coding and billing practices, increases timeliness and accuracy of federal and state reimbursement, and any other reporting metrics that provide benchmarks to improvements.
Responds in a timely manner to requested and/or mandated charge master changes from the CDM Analyst.
Investigates and documents any potential for new program and product development.
Submits recommendation to make internal changes as needed to keep the facility coding and chargepractices compliant with applicable rules and regulations.
Develops data and creates analysis regarding effects on revenue due to requested or mandated changes to the CDM and/or billing practices.
Adheres to established productivity standards, participates in departmental performance improvement activities and work level.
Communicates and works with all internal and external customers.
Performs and participates in other related duties as required.
Minimum Qualifications: To qualify you must have a Bachelor's Degree (or equivalent) in Nursing, health-related field, Accounting, Finance, Management or related field and a minimum of 2 years of related experience, or an equivalent combination of education and work experience.Work experience with PCs, word processing, spreadsheet, graphics, and database software applications. Proficient in payment review systems, hospital information systems, clinical record information systems, and some coding methodologies. Strong quantitative, analytical, interpersonal and communication skills.Understand medical records, hospital bills, insurance terms, payment methodologies and the charge master.Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new regulations, policies and procedures.Knowledge of coding guidelines, both ICD-9-CM and CPT-4 and understands CMS (formerly HCFA) Memos and Transmittals and all ancillary department functions for the facility.
Qualified candidates must be able to effectively communicate with all levels of the organization.
NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.
NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online. If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal 'EEO is the law' poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information. To view the Pay Transparency Notice, please click here.
NYU Langone Medical Center, a world-class patient-centered integrated academic medical center, is one of the nation's premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals – Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, one of... only five hospitals in the nation dedicated to orthopaedics and rheumatology; and Hassenfeld Children's Hospital, a comprehensive pediatric hospital supporting a full array of children's health services across the medical center – plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The medical center's tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education and research. For more information, go to www.NYULMC.org.