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Billing Qual Compliance Auditor II

Company: Kaiser Permanente
Location: Pasadena
Posted on: January 13, 2019

Job Description:

Description: Accountable for conducting various revenue cycle audits including, but not limited to, professional bills, hospital or facility bills, automated charge trigger functions, manual charge capture functions, and any additional ad hoc assessments required by the Revenue Cycle Division of the Southern California Region. Responsible for the preparation, the assessment, and the collection of audit findings. Serves as subject matter expert on different levels of revenue cycle in accordance to regulatory requirements set forth by lines of business, state, and federal agencies and as needed, may prepare and deliver training to the Professional Service Coders and other Revenue Cycle personnel for improvement outcomes. Essential Responsibilities: Conducts bill/claim audits for professional and hospital claims (encompasses both CMS-1500 and UB04 claim formats). Assesses claims for various lines of business including, but not limited to, Medicare, MediCal, USDOL, State Workers' Compensation, Third Party Lien, Self-pay, and DHMO. Utilizes expert knowledge of coding based on AMA's CPT, ICD-9-CM, HCPCS II, and OMFS guidelines. Reviews claim fields in accordance with the Gold Standards set forth by each payer and mandated by the organization. Applies expertise on different levels of regulations. These regulations vary by each line of business or payer. Follows specific state and/or federal regulations on billing and coding. Conducts pre and post implementation assessments of various automated and manual charge captures. Assesses quality of various automated charge triggers as implemented. This includes, but not limited to, ambulatory E/M, radiology, laboratory, and pathology services/charges. Assesses accuracy of various manual charge captures as implemented. This includes, but not limited to, infertility and non-KP facility professional charge captures. Identifies effectiveness and opportunity for improvement on various revenue cycle processes, i.e. manual and/or systemic processes, pertaining to or affecting charge trigger functions. Identifies, in detail, any conflicting and accurate data collected and reported that pertains to bill samples. Captures and reports audit findings to the highest quality. Records audit findings in accordance with Quality Monitoring and Reporting unit's policies and procedure to ensure complete and consistent audit data capture. Maintains timely capture and completion of audit data collection. Obtains all necessary documents/data that support bill data. Partners with different Revenue Cycle departments to obtain key documents necessary to conduct assessments completely and effectively. Accesses various KP systems to supplement any paper documents available. This includes, but not limited to, various mainframe systems such as OPAS, IM81, ARRS, and CPM; various KP HealthConnect Hyperspaces and modules; OHSM; ePremis; ImageSilo; ExpressBill; Crystal Reports; and any additional systems identified to be necessary. Provides subject matter expertise on billing and coding guidelines and regulations as required by the department. Conducts research of different regulations pertaining to any revenue cycle functions as required. Supports the department by providing subject matter knowledge on various billing, revenue cycle, and coding topics. As needed, may develop and present training curricula to Professional Coders and other Revenue Cycle personnel for improvement outcomes. Basic Qualifications: Experience Minimum eight (8) years of experience in healthcare with at least five (5) years experience in healthcare billing, coding, and auditing of revenue cycle functions. Education Bachelor's degree in finance/business or healthcare, OR four (4) years of experience in a directly related field. High School Diploma or General Education Development (GED) required. License, Certification, Registration Certification as Certified Professional Coder (CPC) OR Certified Coding Specialist- Professional (CCS-P), AND Certified Coding Specialist (CCS) - Hospital/Facility. Additional Requirements: Hands-on experience on billing, coding, medical chart documentation with demonstrated knowledge of compliance and risk management practices. Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications: Training experience of Revenue Cycle functions. Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Accounting, Finance and Actuarial Services Department: SCAL Revenue Cycle Travel: No Click here for additional requirements > SDL2017

Keywords: Kaiser Permanente, Pasadena , Billing Qual Compliance Auditor II, Accounting, Auditing , Pasadena, California

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