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Inpatient Coder Auditor

Job Description

The Inpatient Coding auditor will be responsible for validating coding based on various Fee Schedules, CMS and Correct Coding guidelines. Generate an audit utilizing Excel and formulating explanation of benefits that correlate with coding determinations. For claims that do not fall under a set fee schedule, a negotiated rate must be agreed upon between the auditor and provider based on guidelines provided by various insurance company policies. Open communication and accurate documentation must be maintained in order to adhere to strict processing deadlines.

Will assist in the evaluation of medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. This individual will also provide guidance and training on medical coding to physicians and staff.

Develop and use analytical tools to regularly review and confirm appropriate usage of the CDM for clients. Provide appropriate follow-up with clients. Reviews Medicare intermediary and other third-party payor bulletins to keep current on billing requirements, and communicates information to all applicable staff and clients. Participate in initiating, developing and establishing facility specific and regional models for financial analyses as it relates to pricing change recommendations to a client’s charge master.

Experience:

  • Minimum of two years’ experience of coding within a Healthcare Organization or consulting group for outpatient and/or physician based services
  • Evidence of audit experience and written reports
  • Supervisory and or mentoring experience preferred
  • Ability to meet deadlines and work under pressure
  • Evidence of good working relationships within a team

Skills:

  • Excellent communication skills
  • Managing people, leadership and motivation and to support others in overcoming barriers to understanding
  • Ability to work independently or as part of a team
  • Methodical, logical and calm
  • Approachable, confident, assertive and hard working
  • Problem solving skills
  • Analytical and organized and an ability to interpret complex information and to use own judgement in finalizing reports
  • Numeracy and accuracy
  • Expertise in the use of Microsoft Office Suite, particularly MS Word, MS Excel, MS PowerPoint, and Visio
  • Experience of presenting highly complex information to audiences with varied levels of understanding
  • Experience in leading training programs and the development of focused training materials for various levels of staff including coders, physicians, and clinicians 
  • Networking: -being able to work within the Organization and with other non – ORGANISATION organization with credibility
  • Must have knowledge of third party billing procedures across a variety of payer systems and have specific expertise in CPT, ICD-9/ ICD-10 and HCPCS coding for a physician group. 
  • Must have a working knowledge of Evaluation and Management (E&M) coding and can conduct chart reviews using the current E&M Guidelines

Preferred Experience/Specialized Skills/Certification:

  • Charge Master and Revenue Integrity experience in Hospital/Physician Practice Operations
  • CDM Review experience
  • Two years consulting experience 
  • Experience managing system wide projects
  • Experience managing consulting projects
  • Epic or Cerner EMR experience highly preferred
  • Previous healthcare financial management or healthcare operations background, and/or clinical experience highly desirable
  •  Staff or client education and training experience
  • PMP Certification
  • CPMA coding certification

Education:

  • Bachelor of Science, Health Administration/Billing/Coding
  • Preferred:  Bachelor of Science, Health Informatics and Health Information Management
  • Required: RHIT, CCA or CCS certification

You want your next step to be the right one. You've worked hard to get where you are today. And now you're ready to use your unique skills, talents and personality to achieve great things. RSM is a place where you are valued as an individual, mentored as a future leader, and recognized for your accomplishments and potential. Working directly with clients, key decision makers and business owners across various industries and geographies, you'll move quickly along the learning curve and our clients will benefit from your fresh perspective.

Experience RSM US. Experience the power of being understood.

RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.

Job Requirements

 

Job Snapshot

Location US-TN-Nashville
Employment Type Full-Time Employee
Pay Type Year
Pay Rate N/A
Store Type Consultant, Information Technology
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Company Overview

RSM US LLP

Effective Oct. 26, 2015, McGladrey united with fellow members of our global network under the common brand name RSM. RSM US LLP is the leading provider of audit, tax and consulting services focused on the middle market, with more than 8,000 people in 80 offices nationwide. It is a licensed CPA firm and the U.S. member of RSM International, a global network of independent audit, tax and consulting firms with more than 37,500 people in over 110 countries. RSM uses its deep understanding of the needs and aspirations of clients to help them succeed. For more information, visit www.rsmus.com. Learn More

Contact Information

US-TN-Nashville
Snapshot
RSM US LLP
Company:
US-TN-Nashville
Location:
Full-Time Employee
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Consultant, Information Technology
Store Type:

Job Description

The Inpatient Coding auditor will be responsible for validating coding based on various Fee Schedules, CMS and Correct Coding guidelines. Generate an audit utilizing Excel and formulating explanation of benefits that correlate with coding determinations. For claims that do not fall under a set fee schedule, a negotiated rate must be agreed upon between the auditor and provider based on guidelines provided by various insurance company policies. Open communication and accurate documentation must be maintained in order to adhere to strict processing deadlines.

Will assist in the evaluation of medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. This individual will also provide guidance and training on medical coding to physicians and staff.

Develop and use analytical tools to regularly review and confirm appropriate usage of the CDM for clients. Provide appropriate follow-up with clients. Reviews Medicare intermediary and other third-party payor bulletins to keep current on billing requirements, and communicates information to all applicable staff and clients. Participate in initiating, developing and establishing facility specific and regional models for financial analyses as it relates to pricing change recommendations to a client’s charge master.

Experience:

  • Minimum of two years’ experience of coding within a Healthcare Organization or consulting group for outpatient and/or physician based services
  • Evidence of audit experience and written reports
  • Supervisory and or mentoring experience preferred
  • Ability to meet deadlines and work under pressure
  • Evidence of good working relationships within a team

Skills:

  • Excellent communication skills
  • Managing people, leadership and motivation and to support others in overcoming barriers to understanding
  • Ability to work independently or as part of a team
  • Methodical, logical and calm
  • Approachable, confident, assertive and hard working
  • Problem solving skills
  • Analytical and organized and an ability to interpret complex information and to use own judgement in finalizing reports
  • Numeracy and accuracy
  • Expertise in the use of Microsoft Office Suite, particularly MS Word, MS Excel, MS PowerPoint, and Visio
  • Experience of presenting highly complex information to audiences with varied levels of understanding
  • Experience in leading training programs and the development of focused training materials for various levels of staff including coders, physicians, and clinicians 
  • Networking: -being able to work within the Organization and with other non – ORGANISATION organization with credibility
  • Must have knowledge of third party billing procedures across a variety of payer systems and have specific expertise in CPT, ICD-9/ ICD-10 and HCPCS coding for a physician group. 
  • Must have a working knowledge of Evaluation and Management (E&M) coding and can conduct chart reviews using the current E&M Guidelines

Preferred Experience/Specialized Skills/Certification:

  • Charge Master and Revenue Integrity experience in Hospital/Physician Practice Operations
  • CDM Review experience
  • Two years consulting experience 
  • Experience managing system wide projects
  • Experience managing consulting projects
  • Epic or Cerner EMR experience highly preferred
  • Previous healthcare financial management or healthcare operations background, and/or clinical experience highly desirable
  •  Staff or client education and training experience
  • PMP Certification
  • CPMA coding certification

Education:

  • Bachelor of Science, Health Administration/Billing/Coding
  • Preferred:  Bachelor of Science, Health Informatics and Health Information Management
  • Required: RHIT, CCA or CCS certification

You want your next step to be the right one. You've worked hard to get where you are today. And now you're ready to use your unique skills, talents and personality to achieve great things. RSM is a place where you are valued as an individual, mentored as a future leader, and recognized for your accomplishments and potential. Working directly with clients, key decision makers and business owners across various industries and geographies, you'll move quickly along the learning curve and our clients will benefit from your fresh perspective.

Experience RSM US. Experience the power of being understood.

RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.

Job Requirements

 
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