Physician Billing Auditing Lead

Overview Ann & Robert H. Lurie Children’s 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 Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report. Location 680 Lake Shore Drive Qualifications Minimum of an associate degree. Coding credentials required: RHIT, RHIA, CPC, CCS, or CCS‑P. 3‑5 years of 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 of medical record practices, standards, regulations, Joint Commission and Illinois Medicaid coding and reporting requirements. Knowledge of medical terminology, anatomy and physiology and coding classification systems, able to apply this knowledge to determine appropriate physician coding. Effective communication with providers, co‑workers and managers. Ability to work independently and balance multiple priorities. Proficiency with coding resources such as 3M, Encoder Pro, NGS (National Government Services), NCCI, CPT Assistant, payer policies. Responsibilities Maintain audit schedule and process for monthly and quarterly audits. Monitor auditor’s productivity in collaboration with the Auditing Manager to meet designated productivity. Perform quality review to meet designated quality accuracy as outlined in the Coder/Auditor Quality and Education Policy. Review work queues daily to ensure encounters not needed for audit are submitted. Perform auditing functions as needed. Act as liaison to providers, managers and other coding team members. Train new auditors on department policies, procedures and auditing software/EMR (Epic). Resolve questions, issues, and patient disputes with third‑party payors, billing coordinators, compliance auditors, external billing company and denial management team pertaining to coding. Prepare department coding feedback based on trends and issue identified in audits and denials. Collaborate 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. Collaborate with Auditing Manager to improve Charge Review work queues workflow through various improvement initiatives. Assist with auditing bi‑monthly meeting content, education materials, room reservations and other tasks. Assist with revenue cycle coding projects. Develop and maintain division‑specific coding protocols for auditing purposes. Assist with employee time management on a weekly basis including staffing coverage. Assign appropriate ICD‑10‑CM diagnosis code(s), CPT procedure codes and modifiers using coding conventions, guidelines and payer‑specific requirements. Abstract and compile data from medical records for optimal reimbursement. Work actively with providers and coders to initiate corrections and resolve discrepancies in coding and documentation. Collaborate with providers to ensure accurate and timely submission of claims related to auditing. Provide feedback at division meetings around documentation and coding trends identified by audit. Submit help desk tickets and system change requests for coding and collaborate with IM for resolution. Provide regular communication and education to providers and other clinical teams as indicated. Perform 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. Perform other related duties as assigned. Education Associate's Degree (Required) Pay Range $70,720.00 – $115,627.20 Benefits 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 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 Children’s facilities Discount purchasing program EEO Statement Lurie Children’s and its affiliates are 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. #J-18808-Ljbffr 10 HOSP Ann & Robert H. Lurie Children's Hospital of Chicago