Payor Audit Documentation Specialist (Non-Exempt)

Education: High school diploma or equivalent certification.Experience:  A minimum of two years’ experience with healthcare coding (CPT, HCPCS, DRG, IDC-10, HIPPS, RUG, Modifiers, Revenue Codes, etc.) and appeals process.Required Certifications: Certification must be obtained within six months of hire in one of these areas: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and/or Registered Health Information Technician (RHIT).Preferred Education: Bachelor’s degree in a related field.Preferred Certifications: Current certification in one of the required areas.  Certification in Healthcare Compliance (CHC), Certified Revenue Cycle Representative (CRCR), Registered Health Information Administrator (RHIA)OTHER SKILLS & KNOWLEDGE:     Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors.     Knowledge of Medicare NCD & LCD guidelines    Ability to critically evaluate and make decisions about whether appeals should be made based on reviews of patient medical records or procedures completed.     Skill in writing convincing appeals arguments that is sound and supported by evidence that is related to patients' specific clinical attributes.    Excellent oral and technical writing and typing skills.     Ability to stay current on changing governmental regulations related to healthcare reimbursement.      Excellent interpersonal, communication and organizational skills to effectively work with others involved in the audit and appeal process.     Must possess the ability to prioritize, delegate, and organize various tasks/projects simultaneously to ensure departmental and Mercy-wide goals are timely met.    Demonstrates personal qualities such as kindness, compassion, understanding, integrity, interest and respect for others.    Ability to maintain confidentiality when working with sensitive information.     Knowledge of computer applications and their implications on the audit and appeal process.    Ability to work independently to accomplish and carry out goals/objectives in a collaborative manner.    Very high personal integrity and work ethic with the ability to demonstrate and obtain.    Ability to travel periodically across the Ministry as required.

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