Billing Auditing/Compliance Manager

Denver, Colorado, Full Time. Competitive Compensation

This position is responsible for pre and post payment claim auditing of medical records and associated clinical documentation to ensure proper coding and charge capture, billing in accordance with standard billing policies and reimbursement principles. Reviews insurance payments and denials and recommends billing corrections. The Billing Compliance Manager will conduct training as needed to help ensure improved accuracy of billing/coding documentation.

Responsible for working collaboratively with other departments in the resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed.

Responsibilities:

  • Patient Claims Compliance Management. Develop and implement a Billing Auditing & Compliance Program. Train staff and monitor results.
  • CPT/ICD-10 Coding. Apply knowledge of CPT and ICD-10 coding guidelines, billing documentation and documentation standards to daily claims management by governing daily workload within full compliance of state and federal billing regulations.
  • Regulatory. Ensure compliance of federal, state and commercial payer billing and payment policies.
  • Billing/Coding. Develop and execute a process to review claims prior to processing ensuring compliance in coding, billing and documentation. Act as the billing and coding expert for the organization. Provide expertise to billing staff in addressing coding questions. Ensure accurate and complete coding daily.
  • Reviews and Appeals. Administer a review process of payments, denials and adjustments looking for opportunities for process improvement and education. Assist in the appeals for denials for incorrect diagnoses for services performed as needed.
  • Process Improvement. Minimize claims cycle-times, defects and rework by evaluating workflow and implementing educational opportunities. Seek opportunities to improve billing processes including increased productivity and accuracy.
  • Auditing. Complete and analyze assigned audits of patient care billing. Document audit in a clear, concise and consistent manner to support all findings and to enable quality assurance reviews which will help ensure accuracy of the findings and that no other issues exist. Prepare written and oral reports on the results of the audits.
  • Education and Training. Develop and execute ongoing training sessions. Meet with providers, clinical and billing staff as identified in the audit compliance plan to educate on identified risk factors from the audit and billing review findings.
  • RCM Assistance. Assist the RCM/Patient Accounts team processing charges or payments when needed to meet department monthly and yearly KPI’s.
  • Risk Management. Initiate and follow through reporting any potentially non-compliant conduct. Intervene when necessary to ensure Practice is compliant. Understand penalties and prevention.
  • Credentialing Compliance. Formalize a Credentialing Compliance Program and ensure regulatory compliance for providers with licensing, malpractice, and insurance coverage.
  • Narcotic Licensing. Reconcile and ensure compliance of narcotic licensing limits.
  • Other duties and tasks as assigned.

Qualifications:

  • Education or Formal Training • High school diploma or GED required
  • Auditing experience of 1-3 years required
  • Certified Coder required. Coding Credentials- CPC
  • Coding experience of at least 3 years using ICD-9/10, CPT, and HCPCS codes required

Preferred:

  • Education or Formal Training • Associates degree or higher preferred
  • Auditing certification preferred but willing to accept applicants willing to become certified once employed
  • Coding experience of 3-5 years preferred

Join Magnolia Medical

Apply for our Billing Auditing/Compliance Manager position

Denver, CO

  • {{ err[0] }}