CU Medicine is dedicated to providing business operations and administrative support to the University of Colorado School of Medicine’s nearly 3,000 providers and is affiliated with the leading medical institutions in the West. Located adjacent to the Anschutz Medical Campus, one of the largest and most advanced academic medical campuses in the country, CU Medicine offers a variety of administrative, technical and healthcare support career opportunities and serves as a resource for patients and physicians.
We are seeking a highly skilled Senior Medical Coding & Documentation Auditor to join our team.
The Senior Auditor is responsible for conducting internal audits of the medical documentation, coding, and billing in a provider setting in accordance with Federal and State regulations and payer policies and procedures. These audits determine whether billed services provided to patients, are consistent with medical record documentation and in accordance with the appropriate third party billing regulations and/or standards. The individual in this position will communicate findings to the Medical Staff and other appropriate personnel, and will provide education on identified issues.
The Senior Auditor will provide oversight, training, guidance and/or assistance to other auditing staff in the daily routine tasks of their position, under the direction of the Audit, Compliance & Education (ACE) Leadership. The individual in this position will assist in assuring consistent quality performance between and among the provider audit team. This position will be responsible for new hire training and is expected to make recommendations to improve workflow, process and productivity. In addition, this position will conduct confidential internal/external compliance reviews, communicate findings with ACE Leadership and perform follow up education as required.
Responsibilities include but are not limited to:
- Conduct internal audits of medical documentation supporting claims billed to third parties to ensure billing is done in accordance with the appropriate third party regulations and/or standards.
- Evaluate the appropriateness of the services and procedures billed based on the supporting documentation.
- Evaluate the appropriateness of diagnoses billed for all services in accordance with coding guidelines.
- Evaluate propriety of the level of service billed for evaluation and management services based on the supporting documentation.
- Conduct training and provide educational sessions for clinicians, and residents to support compliance with third party documentation and billing standards and to present new information including yearly updates and changes in requirements.
- Provide follow-up reviews after initial training of physicians and determine if additional education is necessary.
- Prepare written reports of the results of the audits and present to management, clinical chairs, physicians, and department billing staff.
- Respond to questions from physicians and School of Medicine (SOM) department administrative staff regarding billing, coding and documentation.
- Provide new hire Auditor training and assist in ongoing training of auditing staff to ensure uniformity and quality of work.
- Prepare and/or revise compliance documentation and billing manuals for routine and special training programs.
- Attend committee meetings as assigned by Department Leadership.
- Participate and oversee joint projects with other internal audit staff and internal CU Medicine departments to resolve billing and documentation issues.
- Perform other duties and complete special projects as assigned by Director.
Requires a bachelor’s degree in healthcare administration (or related field) or 5 yrs. relevant work experience. Must possess an active CCS-P or CPC or RHIA/RHIT certification in conjunction with auditing credentials (i.e. CPMA). Demonstrated knowledge of Medical Terminology and Anatomy & Physiology combined with high level expertise in third-party payer reimbursement, coding, and documentation requirements are essential to success. Knowledge of Medicare and Medicaid regulations is required. Must have experience in Evaluation and Management coding. Experience in a teaching/academic medical environment is a plus. The ideal candidate will demonstrate superior communication skills including verbal, written and large audience presentations. High level proficiency in the use of various computer systems including Microsoft Word, Excel, PowerPoint, and other database software skills are required.
TO APPLY FOR THIS POSITION, please visit our website at www.cumedicine.us. Reference job #320. All applications MUST be submitted via our website.
CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. We are an equal opportunity employer.
CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.