Description
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.
As our Hospital Outpatient Coding Auditor, you will review hospital charges against medical record and all applicable documentation to determine appropriate code assignments on services provided (CPT/HCPCS codes). The Auditor must have a comprehensive understanding of medical terminology, coding, contractual agreements, and various payment methodologies. This position requires good time management skills and the ability to work independently.
Roles and Responsibilities
- Review hospital charges against medical record and all applicable documentation to determine appropriate code assignments on services provided (CPT/HCPCS codes)
- Understand billing and coding requirements for government and commercial payers.
- Abstract statistical data from the patient record and enter information following facility guidelines.
- Follow all HIPAA regulations and uphold a higher standard around privacy requirements.
- Maintain at least a 95% accuracy rate.
- Maintain productivity standards, tracking logs and deadlines.
Required Skills
- CPC, CPC-H (COC), CPMA, CIC, RHIA, RHIT and/or CCS-P certification
- Experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.
- Experience coding multi-specialties preferred that may include trauma, orthopedics, cardiology, interventional radiology, and neurology.
- Must possess a demonstrated knowledge of clinical processes; clinical coding (CPT, HCPCS, ICD-10, revenue codes, status indicators, and modifiers), charging processes and audits.
- Knowledge of CMS guidelines, Ambulatory Payment Classification, and Outpatient Prospective Payment System, reimbursement structures and prebill edits including Outpatient Coding Edits/Correct Coding Initiative edits preferred.
- Experience with encoder technology and electronic medical record systems.
