Job description
Who We Are
JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.
Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance
outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.
Why JPS?
We're more than a hospital. We're 7,200 of the most dedicated people you could ever meet. Our goal is to make sure the people of our community get the care they need and deserve. As community stewards, we abide by three Rules of the Road:
1. Own it. Everyone who wears the JPS badge contributes to our journey to excellence.
2. Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.
3. Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.
When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!
For more information, visit www.jpshealthnet.org.
To view all job vacancies, visit www.jpshealthnet.org, www.jpshealthnet.org/careers, or www.teamacclaim.org.
Job Title:
Sr Compliance Coding Auditor
Requisition Number:
30197
Employment Type:
Full Time
Division:
RISK MANAGEMENT
Compensation Type:
Salaried
Job Category:
Business / Professional
Hours Worked:
Location:
JPOC 1350
Shift Worked:
Job Description:
Job Summary: The Sr Compliance Coding Auditor is responsible for performing coding audits and participating in revenue cycle integrity reviews on behalf of the Internal Audit Department of the Governance Division of JPS. This includes, but is not limited to, conducting audits of Facility and E/M claims submissions which validate coding accuracy and clinical documentation integrity. Incumbent may also partner with, or oversee, external audit vendors to ensure compliance with Federal and State billing and coding regulations and commercial payers’ contract terms.
Essential Job Functions & Accountabilities:
- Leads and performs coding and billing audits to validate accuracy and completeness of ICD diagnosis and procedure codes, CMS DRG assignment appropriateness. i.e. to evaluate the appropriateness and medical necessity of services and procedures billed based on supporting documentation; evaluate appropriateness of ICD, HCPCS and CPT codes, evaluate the appropriateness of APC, DRG and admission assignments; evaluates appropriateness of modifier usage; make determinations of overpayments and underpayments and performs other related analysis and evaluations.
- Leads and performs compliance billing and coding investigations (internal and external). Proposes action plans to address potential areas of improvement and/or noncompliance. Create and provide education from audit results when applicable.
- Leads and performs coding and billing audits to validate accuracy and completeness of ICD diagnosis and procedure codes, CMS DRG assignment appropriateness. i.e. to evaluate the appropriateness and medical necessity of services and procedures billed based on supporting documentation; evaluate appropriateness of ICD, HCPCS and CPT codes, evaluate the appropriateness of APC, DRG and admission assignments; evaluates appropriateness of modifier usage; make determinations of overpayments and underpayments and performs other related analysis and evaluations.
- Leads and performs compliance billing and coding investigations (internal and external). Proposes action plans to address potential areas of improvement and/or noncompliance. Create and provide education from audit results when applicable.
- Assists the Internal Audit Manager to ensure the work plan audits are timely and appropriately conducted to include, but not limited to, creating and overseeing the appropriate audit spreadsheet; i.e., tools appropriate research of the audit scope in respect to Medicare/Medicaid requirements as well as other third party requirements; finalization of the audits; communicate findings with leaders, physicians, and clinicians; provide education where applicable; and updating of the work plan of such.Responsible for performing a variety of activities in support of internal audit and compliance program initiatives.
- Assists with the creation and/or modifying of new or existing policies and procedures based upon regulatory developments and compliance monitoring as well as auditing activities/processes/findings.
- Coordinates Recovery Auditor Contractors’ (RAC) and payers audit/overpayment requests to ensure timely dissemination; timely appeals and timely identification and return of overpayments; oversee, develop and coordinate RAC reports including but not limited to dollars at risk; responding timely to requests, etc.
- Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to Leadership, implements and monitors results as appropriate in support of the overall goals of the organization.
- Oversees patient’s right to amend protected health information when appropriate.
Qualifications:
- Associates or Bachelor Degree in Healthcare Administration, Business Administration or a related field of study from an accredited college or university.
- 7 plus years’ experience performing coding or revenue cycle functions.
- 2 plus years’ experience with ICD10.
- Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or other relevant coding certification. Preferred Qualifications:
- Five plus years of progressive billing compliance audit experience.
- Registered Health Information Administrator (RHIA) - Registered Health Information Technician (RHIT). Licensure/Certification/Specialized Training:
- SAVE Immigration Verification Training.
Required Qualifications:
Location Address:
1350 S. Main Street
Fort Worth, Texas, 76104
United States
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