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Under general direction, implements billing audit schedule for all clinical services based on analysis of risk and University policies; performs audits of physician medical records to ensure documentation reflects services billed; conducts interviews; maintains records; communicates with Executive Director of University Compliance, department chairs, faculty and staff to report results and issues; collaborates with Research Compliance team in development, implementation and analysis of clinical trial billing.
-Knowledge of University policies and procedures
-Knowledge of federal, state, and local research compliance regulations
-Knowledge of CPT, ICD-9 and ICD-10 coding
-Knowledge of medical terminology
-Highly developed analytical skills
-Counseling/advising/human relations skills Verbal, written and other interpersonal communication skills
-Ability to manage multiple tasks simultaneously
-Ability to maintain confidentiality
Bachelor’s degree in healthcare or related field; supplemented with two (2) years of related work experience; with two (2) years of medical auditing preferred. Certified Professional Coder certification required.
Monitors and audits compliance and statutory, regulatory, and contractual requirements and/or University policy pertaining to clinical billing activity; audits activities on-site; interviews personnel; reviews written materials and source documentation; creates statistical analysis; conducts audits for accuracy of coding and physical presence of physicians involved with professional fee billing and ad hoc audits.
Supplies specific guidance to the University medical community and administration in the development of compliant University policies related to billing requirements and regulations, including current and pending medical billing classification lists known as ICD-9 and 10
Coordinates with the Executive Director of University Compliance on the annual audit plan and provides ongoing updates to the executive director on physician billing concerns.
Offers expertise in reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified health care providers in the office or facility setting
Collaborates with Research Compliance team in development, implementation and analysis of clinical trial billing. Serves team as expert on professional billing.
Performs other duties as assigned.
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