Code Based Reimbursement Auditor
Company: Franciscan Missionaries of Our Lady Health System
Location: Baton Rouge
Posted on: January 15, 2022
The-- -Code-Based Reimbursement Analyst-- -performs audits of
Charge Master driven and HIM assigned codes and medical record
documentation against the itemized charges and facility assigned on
government and non-government accounts and adjusts them for
incorrect items and/or services; Assists with billing edit
resolution and provides coverage guildelines for billable services.
Relies on education, some experience and judgment to accomplish job
and works under general supervision. Creativity and some latitude
is expected to complete responsibilities of the role. Job Duties
Daily and/or weekly websites are reviewed to include the Federal
Register Medicare and Fiscal Intermediary transmittals, bulletins,
and memorandums, including NCD, LCD/LMRP, OCE, and CCI edit
management, payment reconciliation, and financial impact analysis.
Written communication of current and pending APC and other
government program regulations is provided to designated hospital
team members. Bi-yearly training sessions to designated hospital
staff and provides education to revenue producing department
managers/directors and ancillary department staff is provided on as
needed basis. All CMS, Medicare and Medicaid bulletins are
reviewed, and internal changes are made as needed to keep the
facility coding and charge practices compliant with applicable
rules and regulations and provides updates to affected departments.
Monthly observations and recommendations are made to prevent future
billing problems. Develops process improvement initiatives from
which government program-related problems can be resolved. Bill
rejections and payment delays due to coding and billing practices
as evidenced by CCI edit and LMRP are decreased, increased
timeliness and accuracy of federal and state reimbursement, and any
other reporting metrics that provide benchmarks to improvements.
Reports are prepared as required by management regarding process
improvement recommendations and systemic claim processing issues.
Minimum Requirements & Education 3 years experience Associate
Degree in Nursing or HIM Licensure Current RHIT or LPN License
Keywords: Franciscan Missionaries of Our Lady Health System, Baton Rouge , Code Based Reimbursement Auditor, Accounting, Auditing , Baton Rouge, Louisiana
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