Compliance Billing Auditor

1. Conduct compliance coding reviews of medical records and supporting documentation against submitted claims, to determine coding and billing accuracy for medical, dental, mental health services, including telehealth and telemedicine services.

1. Research and interpret FQHC and Medi-Cal specific coding and billing guidelines and internal policies and procedures to verify claims billing accuracy.

1. Observe and report opportunities for documentation improvement.

1. Identify documentation trends and topics for education/feedback.

1. Other duties as assigned.
    
   COMPENSATION:
   
   SALARY: $44,467.32 - $63,859.08  
    

QUALIFICATIONS:

MinimumQualifications:

1. One (1) to three (3) years of experience in medical billing and/or coding in an outpatient and ambulatory care settings.

1. College level courses in anatomy, physiology, and medical terminology.

1. Demonstrated knowledge of CPT, ICD-10and applicable billing terminology.

1. Background in medical billing, coding or auditing of insurance claims and medical records

1. Demonstrated understanding of payer rules and regulations, including Medicare and Medicaid.

1. Demonstrated knowledge of clinical compliance, best practices, medical record review, legal aspects of documentation, etc.

1. Previous FQHC experience with 340B, Grants and Clinical operations and Federal and State regulations preferred.

Special Conditions of Employment:

1. Ability to acquire a Medical Coding Certification from AHIMA and/or AAPC (CCS, RHIA, RHIT, CIC, ROCC, CPC, COC, CPC-P, CRC, CPMA, CPDS) to be maintained annually.

Knowledge, Skills and Abilities:

1. Excellent oral and written communication skills.

1. Effective interpersonal skills.

1. Computer proficiency, including programs such as MS Office, Word, Excel, email, and internet research, required.

1. Must possess ability to navigate clinical information systems for accessing health information in an electronic environment

1. MustpossesstheabilitytoeducateandtrainComplianceandClinicalstandardstostaffmembers

1. Must be able to travel as needed.

1. Ability to effectively elicit/provide information to and from appropriate individuals(including, but not limited to, supervisors, co-workers, patients)via strong communication skills.

Physical and Mental Requirements:

1. Able to lift/move up to 40 pounds, move from place to place, and stand for long periods of time

1. Ability to do math, organize and prioritize workload, work effectively and efficiently under stress

1. Ability to supervise, multi task, understand and follow instructions

1. Ability to proficiently read, write, speak and understand English

CUSTOMERSERVICE:

1. Actively supports, promotes, and works to fulfill the Mission, Vision and Core Values of Borrego Health.

1. Provides excellent internal and external customer service.

1. Demonstrates Borrego Health’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.

1. Participates in on-going customer service trainings.

1. In every action, seeks to promote Borrego Health as a top service organization.

SAFETY:

1. Ensures compliance with policies and procedures related to safe work practices.

1. Uses all appropriate equipment and/or tools to ensure work place safety.

1. Immediately reports unsafe working conditions.
    

PRIVACY/COMPLIANCE:

1. Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need to know basis for business purposes only.

1. Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.

1. Upholds strict ethical standards

1. Promotes standards of professional and ethical conduct.

Flexibility: Available for all shifts and, when required, able to work evenings and weekends.