Medical Billing Compliance Consultant – Remote, US

Reviews audit findings documented by the Medical Billing and Coding department’s analysts, as well as the audit findings of Coding Auditors and develops policies and procedures, educational materials, and/or presentations to Medical Billing and Coding staff in an effort to maintain a climate dedicated to medical billing and coding compliance. May be required to discuss audit findings with the auditee and/or his/her supervisor.  Summarizes findings and reports to appropriate parties at prescribed intervals (weekly, monthly, quarterly, etc.).  Receives medical billing and coding questions or concerns reported to the department and conducts research of Federal, State, payer-specific billing guidelines and internal policies and procedures when responding to such inquires or reports.  Conducts peer review and provides guidance to the department’s analysts.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Respond to billing and coding questions, concerns presented by staff and/or clients
• Conduct research to answer billing and coding questions, concerns posed by staff and/or clients
• Present research findings to the party posing questions or raising concerns
• Maintain a database of all questions or concerns received, resources utilized in rendering an opinion, and final response and/or corrective or preventive actions taken.
• Work with the TB RCM Edit Optimization workgroup to research current TB RCM edits to determine if they are compliant with Federal and State medical billing and/or coding guidelines.  Suggest which edits must be revised, deactivated, or combined to prevent duplication.
• Work with the TB RCM Edit Optimization workgroup to research incoming requests for TB RCM edits to ensure they are compliant with Federal and State medical billing and coding guidelines.  Approve or deny each edit request accordingly or suggest modifications to the edit requested.
• Maintain a database of all TB RCM edits requested, reviewed, or suggested, as well as a log of TB RCM sites receiving each edit.
• Review medical billing and medical coding compliance audit results to determine the need for policies, procedures, educational materials, and/or changes to computer systems to ensure medical billing and medical coding compliance
• Routinely review CMS (Centers for Medicare and Medicaid Services) and/or Federal Register publications to identify billing rule changes that impact medical billing or coding compliance.
• Maintain a database of key official resources utilized by the department when rendering opinions
• Suggest new TB RCM edit requests based on audit results and/or new rules or rule changes published by a Federal or State payer and/or within the Federal Register or by any other official billing or coding resource, such as the AMA’s CPT Assistant or AHA’s Coding Clinic.
• Alert department leader when TB EHR, TB Encoder, and/or TB RCM when a medical billing or coding product is impacted by new rules published.
• Alert department’s leader when TB CBO, TB EBO, and/or TB Coding services are impacted by new rules published.
• May be required to present audit findings to the auditee
• Summarize findings and report to department’s leader and/or other management
• Develop training materials as they pertain to medical billing and medical coding compliance
• Develop policies and procedures as they pertain to medical billing and coding compliance
• Conduct presentations to medical billing and/or medical coding staff
• Other duties as assigned

Minimum Requirements:

Education/Experience/Certification Requirements

• In-depth knowledge of Medicare hospital billing rules with a minimum of 2 years’ worth of recent Medicare hospital billing experience (within the last 6 months)
• Experienced in conducting research of Medicare billing rules
• Prior experience in conducting research regarding Medicare billing concepts
• Excellent communication (written and oral) and interpersonal skills.
• Strong organizational, multi-tasking, and time-management skills.
• Detail-oriented and able to follow through on issues to resolution.
• Able to act both independently and as a team member.
• Comfortable speaking in a group setting
• Able to present audit findings in a confident and constructive manner
• Able to teach billing compliance concepts to an individual or in a group setting
• Excel experience (experience using Excel formulas preferred)

Preferred Qualifications:

• 5 years prior Medicare hospital billing experience preferred
• Acute Hospital and CAH Medicare billing experience preferred
• Prior coding experience in a hospital setting preferred (DRG and APC assignment)
• Familiarity with TB RCM and its settings is preferred
• Experience with TB EHR table maintenance is favorable
• Prior billing compliance auditing experience favorable

Why join our team?

If you join us, you will receive:

• Work remotely with a work/life balance approach
• Robust benefits offering, including 401(k)
• Generous time off allotments
• 10 paid holidays annually