Cleveland Clinic
- Akron, OH
- Permanent
- Full-time
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Job Title Specialist Audit/Billing Coding
Location Akron
Facility Akron General Medical Center
Department PFS-Cleveland Clinic Akron General
Job Code AK0754
Shift Days
Schedule 8: 00 am-4: 30 pm
Job Summary Under the instructions of the Supervisor, Claims Denial and Audit, the Audit Specialist, Billing and Coding is accountable for handling the everyday billing and coding auditing efforts for the Patient Financial Services department. The Audit Specialist reacts to declare edits connected to Medical Necessity guidelines and Correct Coding Initiative (CCI) guidelines. The Audit Specialist examines billing and coding and offers department education and assistance. The Audit Specialist reacts to questions and offers assistance concentrated on compliance and coding guidelines.
Job Details
- Reviews Medical Necessity and CCI edits and helps in getting precise details for certified billing.
- Participates in evaluation and research study of brand-new services under factor to consider for addition to the CDM.
- Serves as a resource to AGHS management and medical personnel by tracking, informing and offering assistance that will help with precise billing and coding practices. Shares brand-new policies with affected departments.
- Updates and preserves intranet resource site of LCDs for all income cycle and scientific departments.
- Performs Verification of Hours (VOH) on Medicaid claims.
- Reviews Short Term Observation (STO) charts for treatments carried out. Records suitable charges in accordance with Medicare billing guidelines and guidelines.
- Works carefully with Health Information Management (HIM), Patient Financial Services (PFS), Patient Access and the medical departments on resolving billing/coding patterns and supply assistance.
- Provides feedback, education and outreach efforts to suitable workers connecting to investigate findings and patterns on billing practices.
- Assists with the conclusion of the yearly compliance work strategy that includes medical, coding and billing evaluations.
- Serves as a resource for coding concerns and issues. Offers assistance for billing.
- Uses due diligence and all readily available resources to guarantee billing codes (e.g., profits codes, CPT codes) precisely show the services offered by AGHS.
- Supports compliance efforts by sticking to relevant organizational standards in addition to federal, state and regional laws. Maintains personal privacy and privacy. Show stability and keeps high ethical requirements. Functions to safeguard the possessions of the company.
- Keeps abreast of compliance activity/trends to guarantee updated understanding of compliance details. Shares info with the suitable Revenue Cycle and secondary department personnel. Takes part in academic and training chances.
- Completes obligatory education and training in order to keep company and department particular proficiencies and requirements. Maintains appropriate certification/licensure.
- Follows medical facility and department policies and treatments with unique attention to participation and punctuality, privacy, gown code and screen of ID badge.
- Other responsibilities as designated
Education:
Certifications:
- RHIT, CCS or other coding accreditation.
Complexity of Work:
- Ability to support others through comprehensive auditing efforts, prompt feedback and academic assistance.
- Knowledge and understanding of confirmation of observation hours (VOH).
- Proven capability to fulfill due dates and alter work top priorities as required.
- Excellent oral, written and discussion abilities.
- Ability to establish and keep strong expert relationships.
- Demonstrated cooperation with others.
Work Experience:
- 2 years coding experience.Demonstrated experience with client accounts and medical records audit analysis.
- Demonstrated capability to utilize the utmost discretion and preserve the strictest privacy when examining, going over, and handling task responsibilities.
- Experience with Microsoft Office programs consisting of efficiency in Access, Excel, PowerPoint, and Word.
Physical Requirements:
Personal Protective Equipment:
- Follows basic preventative measures utilizing individual protective devices as needed
The policy of Cleveland Clinic Health System and its system healthcare facilities (Cleveland Clinic Health System) is to supply level playing field to all of our staff members and candidates for work in our tobacco complimentary and drug totally free environment. All deals of work are followed by screening for illegal drug and nicotine. Task deals will be rescinded for prospects for work who check favorable for nicotine. Prospects for work who are affected by Cleveland Clinic Health System’s Smoking Policy will be allowed to reapply for employment opportunities after 90 days.
Cleveland Clinic Health System administers an influenza avoidance program in addition to a COVID-19 vaccine program. You will be needed to adhere to both programs, which will consist of getting an influenza vaccination on a yearly basis, and being completely immunized versus COVID-19, or acquiring an authorized exemption.
Decisions worrying work, transfers and promos are made upon the basis of the very best certified prospect without regard to color, race, faith, nationwide origin, age, sex, sexual preference, marital status, origins, status as a handicapped or Vietnam period veteran or any other particular safeguarded by law. Details supplied on this application might be shown any Cleveland Clinic Health System center.
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