At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Responsible for auditing physician evaluation and management and procedures coding and billing to ensure they meet the official coding guidelines, medical necessity and compliance with regulatory requirements.
Responsibilities:
Prepare formal audit report of audit background, steps and findings to presentation to executive leadership and the Board of Commissioners.Participates in investigations and responds to questions, issues, reports and formal inquiries by federal and state agencies of possible violations or non- compliance matters raised by employees, patients, physicians and the public.Monitor and assess compliance with state and federal laws and the System's policies and procedures to identify deviations and recommend corrective action.Follow up on audit findings to ensure that the corrective action plans are effective.Ensures compliance with regulatory agencies governing healthcare delivery, third party payers, and accrediting bodies.Communicates with and educates employees on the Memorial Healthcare System (MHS) Compliance Program.Audits medical records to verify documentation supports medical necessity and the accuracy of ICD-10 coding and evaluate the completeness of documentation to support procedure code assignment and services billed.Review Memorial Physician Group (MPG) physician coding and billing for evaluation and management office visits and procedures.Research all MPG Physicians on the Center for Medicare and Medicaid (CMS) national disclosure program database for financial relationships between drug and medical device companies and verify that the physician disclosed this information on their annual Conflicts of Interest questionnaires.
Competencies:
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTHCARE INDUSTRY, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR
Education and Certification Requirements:
Associates (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Professional Medical Auditor (CPMA) - American Academy of Professional Coders (AAPC)
Additional Job Information:
Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships. The incumbent must be able to lead.
Required Work Experience: Three (3) years of experience in coding in a physician practice setting or auditing physician practice coding and billing.
Other Information: Additional Education Info: Associate's degree in Health Information Management, Health Information Technology, Health Informatics, or related field. Bachelor’s Degree preferred.Additional Certification Info: Certified Coding Associate (CCA from AHIMA) or CPC - Certified Professional Coder – American Academy of Professional Coders (AAPC) or HCC - Hierarchical Condition Category – American Academy of Professional Coders (AAPC) or CRC - Certified Risk Adjustment Coder – American Academy of Professional Coders (AAPC) or CPMA - Certified Professional Medical Auditor – American Academy of Professional Coders (AAPC).
Working Conditions and Physical Requirements:
Shift:
Primarily for office workers - not eligible for shift differential
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net
Be at the heart of exceptional care.
Team MHS Florida is an award-winning group of friends and colleagues at one of the largest not-for-profit health systems in the nation. We're 17,000 strong, advancing towards a brighter future together. We're passionate about the work we do, delivering deep, personalized care for patients and their families. That’s what we call the Memorial Experience.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
