Auditor

Job Number: 26-00061

Progress on your Journey to success! ECLARO is currently recruiting for an Auditor in the Chicago, IL area for one of our clients.

ECLARO’s client is a leading provider of healthcare workforce software and solutions. If you’re up to the challenge, then take a chance at this rewarding opportunity!

Position Overview:

• As a key role in the Revenue Integrity team, the Auditor & Educator is responsible for conducting reviews of EMR documentation of patient encounters to ensure coding accuracy and documentation adequacy.
• The professional will work collaboratively with clinical providers to improve revenue cycle integrity while seeking and identifying trends and opportunities for coding optimization.
• The incumbent will regularly conduct coding reviews of CPT, ICD-10, and modifier utilization.
• Provide feedback and focused educational programs on the results of auditing, review claim denials pertaining to coding, and implement corrective action plans.
• Exemplifies the Client mission, vision and values and acts in accordance with Client policies and procedures.
  
  

Pay Rate: $50.00/Hour

Responsibilities:

• Coordinates, schedules, and performs reviews of professional services and documentation performed by RUMG & ROPPG providers.
• Evaluates clinical documentation to identify inconsistency or improvement opportunities that could impact reimbursement, revenue integrity, and/or reduce denials.
• Reviews charge information submitted by certified coders, claim forms, and insurance correspondence to determine if coding, billing, claim follow-up, payment receipts, posting activities, and credit processing is being performed in an accurate and timely manner and is supported by documentation.
• Prepares written reports of the audit findings to internal leadership, clinical leadership, and providers.
• Develops educational presentations, learning tools, and training material.
• Provides education for both providers and coders for appropriate CPT, ICD-10, and modifiers based on supporting documentation and EMR charge capture support.
• Serves as a liaison point of contact for clinical coding inquiries and communication for professional billing revenue cycle
• Seeks to establish collaborative relationships with physician leaders, clinical providers, IS, Corporate Compliance, Revenue Cycle, and administrative leadership in the support of coding education and documentation adequacy.
• Assists with claim denial reports to ensure optimal reimbursement
• Analyzes billing trends to identify areas of noncompliance and prepares regular reports on review
• Assists in the development of corrective action plans and participates in compliance investigations as needed.
• Manages special projects individually or in collaboration with other departments.
• Track coding quality and documentation improvements to measure ROI, organizational growth and support of CPI initiatives.
• Performs job functions adhering to service principles with customer service focus on I-Care values. health care billing software knowledge, experience in Epic Ambulatory. Position
  
  

Required Qualifications:

• Bachelor's Degree in lieu of bachelor's degree, an associate's degree with 5 years of auditing experience required.
• Certified Professional Coder (CPC) or Certified Coding Specialist- Physician Based (CCS-P)
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification in conjunction with physician-based coding experience, including evaluation & management (E/M) and surgical coding experience, may be considered contingent upon CPC or CCS-P certification being acquired within the first 6 months of employment.
• Three years of E/M and/or surgical coding experience.
• Extensive knowledge of federal, state, and payer specific regulations and policies pertaining to
• documentation, coding, and billing, with demonstrated ability to interpret such guidelines.
• Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in CPT, ICD-10-CM and HCPCS code assignment by passing a department administered coding proficiency test.
• Demonstrates commitment to continuous learning and performs as a role model to other coding staff.
• Strong communication and organizational skills.
  
  

Preferred Qualifications:

• Certified Professional Medical Auditor (CPMA) and/or Surgical Coding certifications
• Experience working in a Teaching Hospital setting.
• Prior experience with billing and claims processing.
• Prior experience working in a hospital or clinical setting.
• Proficient in Excel, Word, Data Entry
  
  

Shift: Day 5x8-Hour (08:00 - 04:30); Job Duration: 26 weeks (with possibility of contract-to-hire)

If hired, you will enjoy the following ECLARO Benefits:

• 401k Retirement Savings Plan administered by Merrill Lynch
• Commuter Check Pretax Commuter Benefits
• Eligibility to purchase Medical, Dental & Vision Insurance through ECLARO
  
  

If interested, you may contact:

Claudine Pamaranglas

Claudine.Pamaranglas@eclaro.com

(332) 209-4547

Equal Opportunity Employer: ECLARO values diversity and does not discriminate based on Race, Color, Religion, Sex, Sexual Orientation, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status, in compliance with all applicable laws.