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Provider Educator/Auditor
Summary
Title:Provider Educator/Auditor
ID:1115
Department:PRL Coding
Description
Practice Resources, LLC (PRL) is seeking a Provider Educator and Auditor.  PRL is a premier medical billing and practice management company centrally located in downtown Syracuse. PRL provides billing, coding, credentialing, information technology, administrative and human resources support services to health care professionals.  PRL offers a competitive salary and benefits package including health, dental, disability and life insurance, 401K/Roth 401K options, paid time off, flex spending, free parking and casual dress every day.  Our office is located just blocks from historic Armory Square allowing quick access to 690, 481 and 81

Responsibilities:
  • Utilization of independent judgment and initiative in performing detailed data analysis.
  • Review physician and other healthcare providers clinical documentation and correlates to charge capturing in order to assign proper coding for professional and technical services provided and billing.
  • Validation of ICD-10, CPT, HCPCS and E&M codes as submitted by providers.
  • Demonstrate ability to plan, coordinate and prioritize daily activities with minimum supervision.
  • Assign and bill to the appropriate Evaluation and Management (E&M) codes based on the clinical and medical documentation evidence to comply with CMS specific guidelines for all carriers, third party reimbursement policies, regulations and accreditation guidelines.
  • Utilizes a high degree of coding knowledge base in a specific medical service line requiring more comprehensive coding skills in order to capture all necessary components and medical necessity requirements.
  • Proactively research coding related complicated cases and contributes to resolution through the use of multiple mechanisms.
  • Verify billable physician services by the review of physician or other healthcare providers documentation.
  • Communicate effectively with Physicians and other healthcare providers.
  • Demonstrate extensive knowledge in coding and billing guidelines
  • Utilize resource materials available appropriately support accurate coding and billing practices.
  • Demonstrate effective and proper communication skills both verbal and written.
  • Maintain Confidentiality, Privacy and Security of patients records and information on and off the premises up to and including on all social media
  • Adhere to all HIPAA regulations State and Federal laws; facilities policies and procedures.
  • Perform any other related or unrelated duties as requested or assigned or deemed necessary for the betterment of the facility and/or for indirect patient care.
Requirements:
  • Requires minimum of 1 year of Hospital/Physician Coding experience using ICD 10, CPT, HCPCS, CCI OCE Edits, Modifiers.
  • Working knowledge of Intellicode, Excel, PowerPoint, and Medent preferred.
  • Working knowledge of medical Terminology, anatomy/physiology, pathology and disease process a must
  • Ability to communicate effectively, both orally and written and have excellent interpersonal skills
  • Highly organized and able to manage workload with prioritization skills
  • Ability to travel to client locations within Central New York
  • Must be CPC, CCS, RHIT, or RHIA certified. CPMA, CEMC, CRC a plus in addition to one of the main credentials.


 

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