Provider Educator / Auditor
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
Responsible for training in CPT assignment for on-boarding physicians and mid-level providers; Auditing new providers as described per policy and re-educating as needed. Audit and educate coding staff as necessary. Reviewing and validating a variety of charges generated from the providers. Performs in accordance with the policies and procedures. Follows standards for ethical business conduct. Conducts self as a positive role model and team member. Participates in facility committees, meetings, in-services, and activities as requested
• Collaborate with other departments to resolve billing problems related to coding, including those stemming from CCI edits and the outpatient code editor (OCE).
• Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings, and proposing recommendations. Oversee implementation of audit recommendations as appropriate.
• Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
• Maintain excellent intradepartmental communication; maintain good rapport with Practice Management and other departments and employees throughout Steward.
• Educate practices/providers on basic coding, documentation, and billing issues related to appropriately charging for, and documenting the services delivered in compliance with applicable rules and regulations.
• Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations.
• Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines.
• Complete required continuous training and education, including department specific requirements.
• Maintains certifications and stays current on industry trend.
Required Knowledge & Skills:
• Experience utilizing Microsoft Office required.
• Experience should include thorough knowledge of health care operations, physician practice reimbursement including RVUs, charging practices, governmental coding requirements including extensive knowledge of CPT / HCPCS / ICD and modifiers, and healthcare financial systems.
• Experience in researching, interpreting and applying Medicare, Medicaid, MASSHEALTH, and other third party payer regulations is essential.
• Superior analytical skills, excellent writing, organizational and interpersonal skills.
• Demonstrated highly developed project management skills, along with excellent problem solving and analytical skills, and verbal and written communication skills.
• Bachelor's degree is strongly preferred.
• 3+ years of related work experience is preferred.
• CPC or CCS-P required. Certification of healthcare compliance (CHC) strongly preferred.