Reimbursement Auditor

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Conduct audits of Charge Master-related and HIM-assigned codes along with medical record documentation against itemized charges and facility-assigned codes across both government and non-government accounts.

• Correct any inaccurate items and/or services.

• Support the resolution of billing edits and offer guidelines for billable services.

• Examine the Federal Register, Medicare and Fiscal Intermediary transmittals, bulletins, memorandums, NCD, LCD/LMRP, OCE, and CCI edit management resources.

• Relay current and upcoming APC and other government program regulations to the assigned hospital team members.

• Deliver training bi-annually to designated hospital personnel and educate revenue-generating and ancillary department staff as necessary.

• Review CMS, Medicare, and Medicaid bulletins, implementing internal modifications to uphold coding and charge-practice compliance.

• Provide monthly observations and recommendations to avert future billing issues and foster process improvement initiatives.

• Minimize bill rejections and payment delays linked to coding and billing practices.

• Prepare reports outlining process improvement recommendations and systemic claim processing challenges.

• Conduct medical record audits to verify that services are accurately documented on itemized statements and associated documents.

• Review focused retrospective claims and records for accuracy while defending facility charging and coding practices during targeted audits.

• Identify coding and billing issues pertaining to APCs and assess outpatient claims for correct CPT-4 and HCPCS Level II coding.

• Create data analyses concerning revenue impacts of changes to the Charge Description Master and/or billing practices.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Minimum of 3 years of relevant experience.

• Associate Degree in Nursing or Health Information Management (HIM).

• Expertise in payment review systems, payment methodologies, and insurance terminology.

• Capability to synthesize and assess data.

• Comprehensive understanding of ICD-9-CM, HCPCS, CPT-4 nomenclature, codes, and guidelines.

• Proficient in the use of 3M coding software.

• Valid RHIT or LPN License.

🏝️ Benefits

• Competitive salary.

• Health, dental, and vision insurance.

• Retirement plan options.

• Continuing education and professional development opportunities.

• Supportive work environment.