Medical Billing Audit Coordinator, PFS Compliance

Position Highlights: 

• Shift Schedule: Full Time (40 hours), Monday-Friday
• Department: Patient Financial Services Compliance
• Location: Atrium Health Wake Forest Baptist in Winston-Salem, NC

What We Offer: 

• Generous PTO: Accrue up to 25 days/year, to be used for vacations, sickness, holidays, and personal matters.
• Education Reimbursement: We invest in your professional growth, offering up to $2,500 per year towards a bachelor’s degree and up to $5,000 per year towards a graduate degree.
• Wellness Incentives: Take advantage of up to $1,350 per year in wellness incentives through our LiveWELL program, prioritizing your well-being.
• Parental Benefits: We understand the importance of family, providing six weeks of paid birthing-mother maternity leave and four weeks of paid parental leave.
• Retirement: Secure your financial future with up to 7% employer-paid retirement contributions.

What You'll Do: Responsible for oversight and management of activities related to external audits requested by payors and/or internal audits arising from questions or concerns involving appropriate coding and billing of health care services from the receipt of the request through the submission of information, including appeals of denials, and/or refunds, as appropriate. Communicates findings, recommendations and/or corrective action plans through written reports and or via collaboration with appropriate parties, including multidisciplinary teams as part of the internal Quality Improvement processes focused on accurate documentation, coding and billing. Job responsibilities include, but are not limited to: 

1. Adheres to the general Enterprise standards to promote a cooperative work environment by utilizing communication skills, interpersonal relationships and team building. 

2. Maintains the integrity and confidentiality of all hospital and patient information. 

3. Develops/maintains effective workflows, policies & procedures, to prepare for and manage external audit requests. 

4. Coordinates the audit request process from receipt of request through response to requesting party (governmental or non-governmental). 

5. Manages the governmental appeals processes related to demand letters for claim recoupment. 

6. Ensures and/or conducts pre-/shadow (for external payors) or initial audits (for internal purposes) to evaluate the appropriateness/accuracy of documentation, coding and billing for health care services based on current coding requirements, governmental and third-party medical policies (including LCDs and NCDs), quality, medical necessity, and other regulatory requirements, as appropriate. 

7. Identifies high risk /vulnerable areas related to documentation, coding and billing to include in the Annual Audit Work Plan. 

8. Coordinates and/or completes written reports detailing audit findings, recommendations and/or corrective action plans. Works with departments, physicians and/or interdisciplinary teams to communicate findings and address issues through recommendations or defined action plans. 

9. Maintains an accurate database of disposition of audit requests. 

10. Coordinates the refund process in the event of payor denials and/or when overpayments are identified as a result of internal audits. 

11. Assists with the development of the Annual Audit Work Plan. 

12. Assists with gathering information needed for preparation of Annual Budget. 

What You'll Need: 

• Associate's degree, equivalent experience, completion of a coding certification program OR graduation from an accredited nursing program with five years working in an academic medical center 
• Two years of which are in a coding/billing review or clinical review position. 
• National Coding Certificate (e.g., CPC, CPC-H) or current licensure to practice as a Registered Nurse in the state of North Carolina (preferred). 

The ideal candidate will also possess the following skills:

• Excellent and effective oral and written communication skills 
• Good project management, problem solving and analytical skills 
• Ability to multi-task and meet deadlines under pressure 
• Ability to work independently and in a team environment 
• Proficient use with various word processing and spreadsheet software 
• Familiarity with physician and hospital coding, charging, billing and collection procedures 
• Ability to understand payment arrangements with third-party insurers, governmental reimbursement and worker's compensation claims 
• Knowledge of regulations and insurance/payor rules related to documentation, coding and billing (especially Medicare, Medicaid) 
• Knowledge/experience with hospital clinical information and Electronic Health Systems (documentation, billing, scheduling, registration, etc.) 

WORK ENVIRONMENT: 

• Clean, comfortable office environment 
• Frequent employee and professional contact 
• Fast pace work and can be challenging