Reimbursement Auditor (Remote in Wisconsin)

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Job Title:

Reimbursement Auditor (Remote in Wisconsin)

Cost Center:

101651059 Coding-Audit Appeals Educ

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

**Wisconsin residents only eligible to apply**

JOB SUMMARY

The Reimbursement Auditor is responsible for auditing medical record documentation to determine appropriate coding/billing for services provided, taking into account American Medical Association (AMA) Current Procedural Terminology (CPT) coding guidelines, International Classification of Diseases (ICD) diagnosis codes, Healthcare Common Procedure Coding System (HCPCS), and Center for Medicaid and Medicare Services (CMS) documentation and billing policies. The individual will typically be working with services coded for outpatient visits, diagnostic visits, emergency department, minor procedures, homecare, hospice, nursing home, dialysis, and other ancillary service records. The Reimbursement Auditor identifies discrepancies in coding and/or documentation with an explanation, so that feedback and education may be provided to all interested parties.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: Successful completion of the following courses per department protocol, within one year of hire: American Medical Association (AMA) Current Procedural Terminology (CPT), current International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), and medical terminology.

Preferred/Optional: Post-high school completion of a medical assistant, surgical assistant, medical transcriptionist, or a medically related healthcare or a coding/billing program. Completion of courses in medical terminology and anatomy/physiology.

EXPERIENCE 

Minimum Required: Experience in healthcare, medical records, or medical business office setting. Knowledge of Medicare, Medicaid, and commercial payer guidelines.

Preferred/Optional: Experience as a medical coder/auditor.

CERTIFICATIONS/LICENSES 

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: Coding certification awarded by the American Academy of Professional Coders, American Health Information Management Association, or other approved coding certification program, within three years of hire.

Preferred/Optional: Coding certification awarded by American Academy of Professional Coders, American Health Information Management Association, or other approved coding certification program at time of hire.

**Wisconsin residents only eligible to apply**

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare.  Successful applicants will listen, serve and put the needs of patients and customers first.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid.  This is a condition of employment.  Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.