Associate Auditor Job in Newark, New Jersey
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Job Title: Associate Auditor
|Type:||FULL TIME, OTHER
|Job Location:||Partial Remote
|Required Certifications:||Physician and NPP Coding certifications (CPC and/or CCS-P) are required
|Location:|| Newark 07101, NJ, US
|Rutgers, The State University of New Jersey, is seeking an Associate Auditor for Ethics & Compliance. The Associate Auditor conducts audits and monitors physician and allied healthcare professionals billing and coding practices. This position is responsible for conducting audits of the medical documentation supporting claims billed to third parties, and governmental payors such as Medicare and Medicaid. These audits determine whether services provided to patients and billed to payers, are consistent with medical record documentation and in accordance with appropriate Federal, state and third party billing regulations and/or standards.
Among the key duties of this position are the following:
- Conducts coding and billing analyses related to internal investigations and interacts with the Office of General Counsel, Office of Labor Relations, Office of Academic labor Relations and Office of Employment Equity, in order to assist investigators in conducting independent and impartial investigations of aligned and non-aligned employees.
- At the direction of the Lead Coding and Billing Auditor communicates those findings to the affected healthcare professional, the department Chairperson, the Medical Staff and other appropriate personnel and provides education on issues identified.
- Applies knowledge of ICD-9, ICD-10, HCPCS, CDT, and CPT-4 coding and guidelines for documentation of billings for physicians and other allied health professionals within the RBHS network on a routine basis to ensure the physicians/allied health professionals are in compliance with Medicare, other federal insurance programs and third party billing guidelines.
- Prepares coding and billing analyses related to internal investigations and interacts with the Office of General Counsel, Office of labor Relations, Office of Academic labor Relations and Office of Employment Equity, in order to assist investigators in conducting independent and impartial confidential investigations of aligned and nonaligned employees in compliance with federal and state law, University policies and applicable collective negotiations agreements (where appropriate).
- Identifies any charges that need to be corrected for erroneous billing and report to the Manager, Coding Compliance.