Physician Billing Auditing Lead

Ann & Robert H. Lurie Childrens Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence kids and their families are at the center of all we do. Ann & Robert H. Lurie Childrens Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

K.S.A.s:

• Minimum of associate degree is required.
• Coding credentials required such as RHIT RHIA CPC CCS or CCS-P.
• Requires 3-5 years coding work experience and additional auditing experience.
• Experience with pediatric multi-specialty healthcare organization preferred.
• Previous experience with project management preferred.
• Demonstrates thorough knowledge of CPT and ICD-10-CM coding.
• Maintains a thorough understanding for medical record practices standards regulations Joint Commission and Illinois Medicaid coding and reporting requirements.
• Demonstrates understanding of medical terminology anatomy and physiology and coding classification systems and can apply this knowledge in determining appropriate physician coding.
• Demonstrates the ability to communicate effectively with providers co-workers and managers.
• Demonstrates the ability to work independently and balance multiple priorities.
• Must be able to utilize coding resources (3M Encoder Pro NGS (National Government Services) NCCI CPT Assistant payer policies).
  

Job Duties:

• Maintains audit schedule and process for monthly and quarterly audits.
• Monitors auditors productivity by collaborating with the Auditing Manager to meet designated productivity.
• Performs quality review to meet designated quality accuracy as outlined in the Coder/Auditor Quality and Education Policy.
• Reviews work queues daily to ensure encounters not needed for audit are submitted.
• Performs auditing functions as needed.
• Acts in the capacity of liaison to providers managers and other coding team members.
• Trains new auditors on department policies and procedures. Trains new auditors on auditing software and EMR (Epic). Reviews auditing process with new coders.
• Resolves questions issues and patient disputes with third party payors billing coordinators compliance auditors external billing company and denial management team that pertain to coding.
• Prepares department coding feedback based on trends and issues identified in audits and denials.
• Works with Coders Coding Manager Auditors and Audit Manager to resolve denials identify trends and implement process improvements to increase clean claim rate and improve denial recovery rate.
• Collaborates with Auditing Manager to improve Charge Review work queues workflow through various work queues improvement initiatives.
• Collaborates with Auditing Manager regarding content for auditing bi-monthly meeting including preparing education materials room reservation and other tasks requirements.
• Collaborates with Auditing Manager to perform and complete revenue cycle coding projects
• Develops and maintains division specific coding protocols for auditing purposes
• Assists Auditing Manager with employee time management on a weekly basis including staffing coverage.
• Assigns appropriate ICD-10-CM diagnosis code(s) CPT procedure codes and modifiers using coding conventions guidelines and payor specific requirements.
• Abstract and compile data from medical records for appropriate optimal reimbursement
• Works actively with providers and coders to initiate corrections and resolve discrepancies in coding and documentation.
• Works collaboratively with providers to assure accurate and timely submission of claims related to auditing.
• Provides feedback at division meetings around documentation and coding trends identified by audit.
• Submits help desk tickets and system change requests for coding and collaborates with IM for resolution
• Provides regular communication and education to providers and other clinical teams as indicated.
• Performs job junctions adhering to service principles with customer service focus of innovation service excellence and teamwork to provide the highest quality care and service to our patients families co-workers and others.
• Performs other related duties as assigned.
  

Education

Pay Range

At Lurie Childrens we are committed to competitive and fair compensation aligned with market rates and internal equity reflecting individual contributions experience and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions.In addition to base salary Lurie Childrens offer a comprehensive rewards package that may include differentials for some hourly employees leadership incentivesfor select roles health and retirement benefits and wellbeing programs. For more details on other compensation consult your recruiter or click the followinglink to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO) Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

• Supplemental Life AD&D and Disability

• Critical Illness Accident and Hospital Indemnity coverage

• Tuition assistance

• Student loan servicing and support

• Adoption benefits

• Backup Childcare and Eldercare

• Employee Assistance Program and other specialized behavioral health services and resources for employees and family members

• Discount on services at Lurie Childrens facilities

• Discount purchasing program

Theres a Place for You with Us

At Lurie Childrens we embrace and celebrate building a team with a variety of backgrounds skills and viewpoints recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly appreciate differences and make meaningful connections that foster belonging. This is a place where you can be your best so we can give our best to the patients and families who trust us with their care.

Lurie Childrens and its affiliatesare equal employment opportunity employers. All qualified applicants will receive consideration for employment without regard to race color sex sexual orientation gender identity or expression religion national origin ancestry age disability marital status pregnancy protected veteran status order of protection status protected genetic information or any other characteristic protected by law.

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