Medical Auditor/CPC -HYBRID

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Job description

Overview:

Employment Type: Full Time

On-Site Position

Benefits: M/D/V, Life Ins., 401(k), PTO, Paid Holidays

Norfolk, Virginia

Pay Range: $25-$30 Hourly

JOB SCOPE: With general supervision of the State Reimbursement Manager, performs complete medical record chart and coding audits for medical and radiation oncology physicians, per The US Oncology Network's established guidelines. Supports and adheres to The US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent who will continue to propel our organization in the right direction and celebrate new successes! Come join our team in the fight against cancer!

About US Oncology
The US Oncology Network is one of the nation's largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit . We extend an extremely competitive offering of benefits to employees, including Medical Health Care, Dental Care, Vision Plan, 401-K with a matching component, Life Insurance, Short-term and Long-term disability, and Wellness & Perks Programs.

Responsibilities:
ESSENTIAL DUTIES AND RESPONSIBILITIES:

Performs paper and EMR chart audits for medical oncology physicians/providers in accordance with The US Oncology Network's requirements in order to ensure medical records are commensurate with captured charges and billing.

May use a variety of reports to accomplish tasks, such as AMA guidelines, Medicare LCD's, commercial payor billing guidelines, coding manuals and ASTRO/ACR guidelines.

All new providers will have an E & M audit within 90 days.

Prepares a spreadsheet of findings that details discrepancies and summarizes metrics.

Identifies trends that could be perceived as non-compliance with local and federal regulatory guidelines.

Recommends procedural improvements and training opportunities to management.

Provides written audit report to supervisor for review and approval.

Reviews approved audit findings with physicians and mid level providers to discuss recommendations and improvement opportunities; radiation audit technical findings will be forwarded to appropriate hospital contact.

Recommends and documents audit procedures, standard reports, and metrics in order to provide the appropriate information.

Maintains the confidentiality of medical information contained in each record.

Assists with other audits such as; hospital visits, consultations, and others as assigned.

Assists with The US Oncology Network's audit and compliance or Reimbursement audits such as providing records, audit reports, and standard operating procedure manuals.

Qualifications:
MINIMUM QUALIFICATIONS:

High School diploma/ GED Required

CPC Required

Nine (9) years of billing, coding, and medical records experience required.

Completion of required The US Oncology Network's Reimbursement tutorials as required by the Compliance Department required.

Internal Billing and Coding Integrity Program certification (BCS-M) in Medical Oncology and (BCIP) in Radiation Oncology.

Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits.

Must possess a strong knowledge of current versions of ICD9, CPT4 and HCPCS.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

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