Facility Auditor
Location: Chattanooga Tennessee
Description: Blue Cross Blue Shield of Tennessee is currently seeking to employ Facility Auditor right now, this occupation will be placed in Tennessee. Detailed specification about this occupation opportunity please give attention to these descriptions. Auditor performs retrospective audits on paid claims, conducts meetings with hospital administrators and department directors, CFO's, and physicians to addres! s audit findings and billing issues. The audits may consist of routine periodic reviews, member requests, employee group requests and requests from other departments within the company. This position may assign and validate documentation for correct coding including but not limited to the following: CPT codes for ER, outpatient surgery, ICD-9-CM codes for primary and secondary diagnoses and procedures, and DRG assignments. The audit findings and other pertinent information must be reported clearly and concisely with recommendations to upper management and the claims recovery areas at BCBST and to hospital administration. Incumbent determines focus and scope of each routine and follow-up or focused audit. Audits include all types of institutional providers and may be performed in-house and on site. Audits may encompass all BCBST products. FunctionsSelects providers to be audited, determines appropriate audit period, scope and size of audit and reviews previous files for hist! orical data. Enters audit request and other appropriate audit ! information in audit system. Reviews patient's records for accuracy of CPT and /or ICD-9-CM coding, correct DRG, appropriate level of care, and covered /non-covered services and supplies. Researches and applies contract information, billing guidelines, and medical policies for all lines of business, verifying that all information submitted is correct and complete. Verifies audit findings with the facility audit coordinator and conducts closeout conference with administration or designee. Provides accurate audit determinations of high quality, report audit findings and recommends course of action as a result of audit findings while maintaining the highest standard of confidentiality. Assists in the development of audit policies and procedures to circumvent creative billing practices and works as a referral mechanism for cases that have quality/risk and case management issues as well as pre-authorization issues and instances of coordination of benefits and aberrant payments. ! Assists in training of audit staff and conducts special assignments as indicated by Management. Regularly interacts with BlueCare Recovery, Medical Directors, claims processing units, HMO Information Management and Health Care Services internally, and hospital personnel including, CEO, CFO, Controller, Medical Records Director, physicians and their office staff as well as multiple other health care professionals. May be assigned special duties and projects by management in addition to those noted above.
Required qualifications include: CCS (Certified Coding Specialist) certification, RN with current licensure in the state of Tennessee, RHIT or RHIA licensure. Will consider candidate with RN, RHIT or RHIA licensure who does not currently hold CCS certification on condition of successful obtaining certification within 18 months of hire. 5 years relevant professional experience with at least 2 years of hospital inpatient coding or at least 5 years of Facility Auditi! ng, or at least 5 years of relevant audit experience in an acute care f! acility, other institutional healthcare provider, or in the insurance industry. Must maintain coding and nursing or health information credentials through CEU's, licensing fees and other criteria pertinent to credentials held. Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic. Must be proficient in use of a PC and related software (e.g. Word, Excel, and Access.) Ability to investigate, analyze and apply contract language, billing guidelines, medical and reimbursement policies. Must have strong written, and oral communication skills and be capable of handling confrontational encounters in a positive manner. Must have proven problem-solving abilities, strong analytical skills, initiative, and the ability to work independently. Must be well organized and have experience managing multiple assignments meeting deadlines. Must be able to travel 70 to 80% of the time.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Blue Cross Blue Shield of Tennessee.
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This occupation starts available on: Sat, 09 Mar 2013 11:42:22 GMT