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Jefferson City Medical Group · 2 months ago

Billing & Compliance Audit Manager

Jefferson City, MO

Full-time

Onsite

Senior Level

$65K/yr - $79K/yr

5+ years exp

Jefferson City Medical Group is seeking a Billing Compliance and Audit Manager responsible for the identification, development, and delivery of provider education related to coding and clinical documentation. The role involves conducting audits and ensuring compliance while collaborating with physicians and the revenue cycle team to optimize reimbursement processes.

BiotechnologyHealth CareHospitalMedical

Responsibilities

Responsible for all aspects of the coding and compliance education and audits of the providers and the coders

Solid analytical skills with the ability to look at the big picture impact and work on project management

Will work independently and use critical thinking skills to problem solve

Uses excellent written and verbal communication skills. Ability to express complex issues and situations in clear and understandable terms. Can understand and carry out oral and written instructions and to request clarification when needed

Billing Compliance and Audit Manager will audit both outpatient and inpatient medical records to verify the appropriateness of diagnostic codes and medical record abstracts

Work with physicians and administration, and the revenue cycle team to ensure complete and accurate information and optimal reimbursement based on coding and abstracting of medical records

Provide excellent public relations and courteous customer service; establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, contractors and other health care personnel

Respond with flexibility and efficiency to frequent changes in task focus, competing priorities, and multiple deadlines

Prepares reports, letters, instructions, emails, and other documents with attention to clarity, tone, composition, and mechanics

Aids in the implementation of new billing requirements mandated by the insurance companies or government

Aid in the setup of new clinics, new entities, new providers, new services for the billing process, including documentation and implementation of the process to ensure goals are met

Aid in developing and implementing new procedures to improve the quality and quantity of work processed. Ensures procedures are documented, communicated, and administered consistently

Leads proactively and is a visionary who influences, mentors and holds staff accountable

Maintain and enforce confidentiality of sensitive information

Analyze problems, perform research, formulate logical conclusions and/or alternatives, make recommendations, and implement solutions

Qualification

Certified Professional Coder (CPC)Certified EvaluationManagement Coder (CEMC)Healthcare professional billingCodingAudit experienceMedical terminologyHealthcare reimbursement systemsAnalytical skillsCustomer serviceSupervisionProject managementCritical thinkingCommunication skillsLeadership

Required

A minimum of an Associate Degree in related concentration such as Health Information

Minimum five (5) years of experience in healthcare professional billing, coding, and audit

Minimum three (3) years of management experience

Billing Compliance and Audit Manager should be a Certified Professional Coder Certificate (CPC)

Certified Evaluation and Management Coder (CEMC)

Principles and practices of healthcare administration; principles and practices of leadership and supervision; principles of work planning and organization

Advanced principles and practices of medical record keeping; advanced medical terminology, anatomy, and physiology, as well as the states, sequence, progression and description of diseases as they apply to medical record coding and abstraction

Current healthcare reimbursement systems and associated regulatory review practices

Appropriate methods for auditing and reviewing information for quality control purposes

The operation of standard office equipment; standard business computer hardware and software

The business and professional relationships and ethics involved among hospitals, physicians and patients

A wide degree of creativity and latitude is expected

Proficient use and extensive working knowledge of billing procedures, application and use of ICD-9- CD-10, CPT and modifiers using professional coding guidelines consistent with Federal Regulations

Acts with confidence, builds credibility and trust