Trinity Health System
Coding and Auditing Manager - Physician Enterprise
Trinity Health System, Steubenville, Ohio, United States, 43953
Coding and Auditing Manager - Physician Enterprise
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Coding and Auditing Manager - Physician Enterprise
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Trinity Health System . Job Summary
The Coding and Auditing Manager Physician Enterprise performs audits and reviews of clinical documentation, provider and support staff billing records, administrative data, and coding records. Responsibilities include rendering appropriate, well-supported, and thoroughly documented decisions, which may identify improper payments (overpayments and underpayments) on claims paid to various providers of clinical services. Ongoing training and education are provided on audit processes, industry changes, and other relevant topics. This role requires a self-motivated, organized, detail-oriented individual with excellent critical thinking and communication skills, in addition to coding and reimbursement expertise. Required Education and Experience
Minimum of five years experience in outpatient coding and/or peer-review auditing is highly desired. Experience with Clinical Documentation Improvement Initiatives and familiarity with Charge Master are preferred. Required Knowledge, Skills, Abilities, and Training
Critical thinking and problem-solving skills; knowledge of ICD-10 and CPT/HCPCS coding and reimbursement. Experience in training and mentoring junior coders or auditors is highly desirable. Experience with clinical documentation improvement initiatives and familiarity with Charge Master. Understanding of Medicare, Medicaid, and commercial reimbursement methodologies; strong data analysis skills. Proficiency with Microsoft Office applications and Windows OS. Willingness to travel for training and onsite reviews as needed. Key Responsibilities
Lead coding and auditing staff, ensuring process oversight and compliance. Review medical records to identify recovery opportunities for outpatient, professional, and allied services. Provide detailed rationale for review findings, including supporting references. Interpret and utilize coding standards, guidelines, NCDs, LCDs, and client payment policies. Contribute to claims selection criteria and educational processes. Collaborate with multidisciplinary teams, including RNs, coders, and support staff. Interact professionally with providers and other personnel. Communicate effectively with management regarding schedule, performance, and technical issues. Maintain productivity and quality standards. Perform additional duties as assigned. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Accounting/Auditing and Finance Industry: Hospitals and Health Care This job posting is active. The position is located in Washington, PA, with a salary range of $90,000.00 - $115,000.00. #J-18808-Ljbffr
Join to apply for the
Coding and Auditing Manager - Physician Enterprise
role at
Trinity Health System . Job Summary
The Coding and Auditing Manager Physician Enterprise performs audits and reviews of clinical documentation, provider and support staff billing records, administrative data, and coding records. Responsibilities include rendering appropriate, well-supported, and thoroughly documented decisions, which may identify improper payments (overpayments and underpayments) on claims paid to various providers of clinical services. Ongoing training and education are provided on audit processes, industry changes, and other relevant topics. This role requires a self-motivated, organized, detail-oriented individual with excellent critical thinking and communication skills, in addition to coding and reimbursement expertise. Required Education and Experience
Minimum of five years experience in outpatient coding and/or peer-review auditing is highly desired. Experience with Clinical Documentation Improvement Initiatives and familiarity with Charge Master are preferred. Required Knowledge, Skills, Abilities, and Training
Critical thinking and problem-solving skills; knowledge of ICD-10 and CPT/HCPCS coding and reimbursement. Experience in training and mentoring junior coders or auditors is highly desirable. Experience with clinical documentation improvement initiatives and familiarity with Charge Master. Understanding of Medicare, Medicaid, and commercial reimbursement methodologies; strong data analysis skills. Proficiency with Microsoft Office applications and Windows OS. Willingness to travel for training and onsite reviews as needed. Key Responsibilities
Lead coding and auditing staff, ensuring process oversight and compliance. Review medical records to identify recovery opportunities for outpatient, professional, and allied services. Provide detailed rationale for review findings, including supporting references. Interpret and utilize coding standards, guidelines, NCDs, LCDs, and client payment policies. Contribute to claims selection criteria and educational processes. Collaborate with multidisciplinary teams, including RNs, coders, and support staff. Interact professionally with providers and other personnel. Communicate effectively with management regarding schedule, performance, and technical issues. Maintain productivity and quality standards. Perform additional duties as assigned. Additional Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Accounting/Auditing and Finance Industry: Hospitals and Health Care This job posting is active. The position is located in Washington, PA, with a salary range of $90,000.00 - $115,000.00. #J-18808-Ljbffr