Voted one of
South Carolina’s “Best Places to Work” for 2019, Lexington Medical Center anchors an expansive health care
network that includes more than 450 physicians and advanced practice providers
at 75 locations across the Midlands.
From general medicine and
orthopaedics to oncology and neurosurgery, these dedicated physicians,
specialists and surgeons combine the highest quality care with advanced
medicine and state-of-the-art technology to help patients achieve the best
possible outcomes. As the third largest employer in the
Midlands, we invite you to become part of our ongoing success and join the
Lexington Medical Center family.
JOB SUMMARY:
·
Analyze and audit LMC systems of the
Physician Network and the hospital medical record data to determine if charges
billed are supported by appropriate medical documentation. Monitors risk areas
and conducts focused audits as identified by the Compliance Audit Manager.
Prepares reports and meets with physicians and Advanced Practice Providers
(APPs) to review audit results.
MINIMUM
QUALIFICATIONS:
·
Minimum Education: Bachelor’s Degree in
Business or Related Field
·
Minimum Years of Experience: 3 Years of
directly related experience
·
Substitutable Education & Experience: A
Bachelors and 3 years of experience can be substituted for the following
combinations of education/work experience:
·
High School Diploma with 7 years of
directly related experience;
·
Associate’s Degree with 5 years of directly
related experience.
·
Required Certifications/Licensure:
Certified Professional Coder (CPC) Certification; Certified Professional Medical
Auditor (CPMA) Certification.
·
Required Training: Strong problem solving
skills;
Ability to articulate orally and in writing an understanding of complex issues
and detailed action plans, while representing the organization professionally.
·
Must be able to communicate with
physicians, Advanced Practice Providers (APPs), senior administrators and
department staff
·
Proficient in Microsoft Office.
ESSENTIAL FUNCTIONS:
·
Responsible
for conducting audits of hospital and Physician Network records to determine
whether services provided to patients are appropriately documented and billed
in accordance with Medicare, Medicaid, and third party billing regulations
and/or standards.
·
Assists the
Chief Compliance Officer in investigating inquires which may relate to
erroneous billing and coding of services.
·
Works
closely with other departments, Health Information Management and Revenue
Integrity to conduct coding reviews and inquires.
·
Drafts
formal written reports that summarize medical record findings for review.
·
Provides
education on subjects pertinent to reviews conducted and any coding and billing
changes to appropriate LMC staff.
DUTIES & RESPONSIBILITIES:
·
Determines
whether medically necessary criteria are met as required by CMS and the fiscal
intermediary through National Coverage Determinations (NDCs), Local Coverage
Determinations (LCDs) and other guidance in effect at the time of the review.
·
Participates
in risk assessment of areas of focus designated by the Recovery Audit Contractors,
MIC, OIG, ZPIC and other regulatory agencies.
·
Consults
with the Revenue Integrity personnel and the Compliance Audit Manager when
relevant issues of federal and state health care billing law and regulations
are discovered to create overpayments.
·
Keeps
abreast of ICD-10, CPT-4, and HCPCS coding changes, compliance issues and
regulations and provides communication and updates regarding changes in
regulations, policies or procedures pertaining to the Compliance Program.
·
Treats
patients, fellow employees and all individuals met while representing Lexington
Medical Center with courtesy and respect in keeping with the LMC vision.
·
Adheres to
District policies.
·
Other
duties as assigned.
We
are committed to offering quality, cost-effective benefits choices for our
employees and their families:
- Day ONE
medical, dental and life insurance benefits
- Health care
and dependent care flexible spending accounts (FSAs)
- Eligible
employees may also enroll in LMC's retirement plans on their date of hire,
including the South Carolina State Retirement System (SCRS)
- Supplemental
401(k)
- 457(b)
retirement plans
- Free
life insurance – equal to 1x salary
- Adoption
assistance
- 401(K) Match
– LMC matches dollar for dollar up to 6%
- LMC provides
its full-time employees short-term disability and long-term disability
coverage after 90 days of eligible employment
- 529 College
Savings
- Tuition
reimbursement
- Student loan
forgiveness
Equal
Opportunity Employer
It
is the policy of LMC to provide equal opportunity of employment for all
individuals, and to remain compliant with applicable state and federal laws and
regulations. LMC strives to provide a discrimination-free environment, and to
recruit, select, on-board, and employ all employees without regard to race,
color, religion, sex, age, disability, national origin, veteran status, or
pregnancy, childbirth, or related medical conditions, including but not limited
to, lactation. LMC endeavors to upgrade and promote employees from within the
hospital where possible and consistent with the employee’s desires and
abilities and the hospital’s needs.