Description :

1. Performed detailed audits of medical claims to ensure accuracy and compliance with ICD-10 and CPT coding standards.
2. Evaluated physician orders and services rendered to confirm proper billing practices.
3. Generated comprehensive reports summarizing audit findings and actionable recommendations for process improvement.
4. Ensured adherence to HIPAA regulations and company policies throughout the auditing process.
5. Provided guidance to healthcare staff on documentation requirements to optimize billing procedures.
6. Led training sessions for new staff on auditing protocols and compliance standards.
7. Collaborated with financial departments to resolve discrepancies and enhance revenue collection.

Experience

0-2 Years

Level

Entry Level

Education

BSN

Description :

1. Performed comprehensive audits of medical charts to ensure accurate documentation and compliance with regulations.
2. Collaborated with healthcare staff to rectify billing errors and enhance documentation accuracy.
3. Identified missing procedure charges, contributing to revenue recovery efforts.
4. Worked closely with the Revenue and Reimbursement Department to ensure correct charge capture.
5. Provided training and feedback to staff to promote meticulous documentation practices.
6. Assessed coding systems and organizational techniques for accuracy and compliance.
7. Engaged with company leadership on financial and regulatory compliance matters.

Experience

2-5 Years

Level

Junior

Education

AAS in HIM

Description :

1. Conducted thorough audits of medical records to detect undercoding and overcoding, ensuring compliance with industry standards.
2. Analyzed billing practices and provided actionable insights to enhance revenue integrity and reduce claim denials.
3. Collaborated with healthcare providers to clarify coding practices and update charge documents effectively.
4. Maintained strict confidentiality of sensitive financial and patient records throughout the auditing process.
5. Participated in ongoing education sessions to stay updated on coding regulations and best practices.
6. Reviewed charts and files across multiple healthcare settings to ensure adherence to JCAHO standards.
7. Identified and reported instances of fraud or non-compliance, contributing to organizational integrity.

Experience

5-7 Years

Level

Senior

Education

BSHIM

Description :

1. Conducted thorough audits of medical claims to ensure compliance with industry standards.
2. Supervised and trained junior staff on auditing processes and regulatory requirements.
3. Analyzed billing practices to identify discrepancies and recommend corrective actions.
4. Collaborated with healthcare providers to verify documentation accuracy.
5. Researched and implemented best practices for claims processing and reimbursement.
6. Utilized analytical skills to recover incorrect claim payments effectively.
7. Maintained detailed records of audit findings and communicated results to stakeholders.

Experience

0-2 Years

Level

Freelancer

Education

AAS in HIT

Description :

1. Conducted thorough audits of medical claims, ensuring accuracy and compliance with state and federal regulations.
2. Identified and resolved billing discrepancies, enhancing revenue integrity and minimizing financial losses.
3. Trained healthcare staff on compliance protocols and best practices for accurate coding.
4. Reviewed clinical documentation for charge audits, ensuring proper billing and coding adherence.
5. Collaborated with payers and providers to resolve claims-related issues and improve processing times.
6. Utilized Electronic Health Record (EHR) systems to audit patient accounts and ensure data accuracy.
7. Generated detailed audit reports for management review, highlighting compliance issues and corrective actions.

Experience

7-10 Years

Level

Management

Education

B.S. in HIM

Description :

1. Conduct thorough audits of medical records for compliance with regulations and standards.
2. Review billing practices to ensure accuracy and adherence to coding guidelines.
3. Identify discrepancies in patient records and recommend corrective actions.
4. Educated nursing staff on audit findings to improve future compliance.
5. Collaborate with healthcare providers to improve documentation practices.
6. Identified root causes of Medical Necessity denials from Medicare insurers.
7. Provided training on Medicare Coverage determinations to prevent future denials.

Experience

10+ Years

Level

Consultant

Education

BSHA

Description :

1. Conducted comprehensive medical and financial audits, presenting findings to healthcare practices and creating detailed audit reports.
2. Performed thorough internal audits to ensure billing codes were accurate and compliant with federal and state regulations.
3. Consulted with healthcare providers on documentation standards and regulatory compliance issues.
4. Provided actionable recommendations to address deficiencies, including organizing educational training sessions.
5. Reviewed medical records to ensure quality care and adherence to health management protocols.
6. Acted as a liaison between healthcare providers and insurance companies to resolve billing disputes.
7. Reported weekly on audit statuses and upcoming projections to the Compliance Manager.

Experience

10+ Years

Level

Executive

Education

B.S. in HA

Description :

1. Conducted comprehensive audits of patient billing charges to ensure compliance with healthcare regulations.
2. Performed detailed reviews of medical records for accuracy and completeness, leading to improved documentation practices.
3. Collaborated with healthcare providers to rectify discrepancies and enhance billing integrity.
4. Implemented auditing protocols that align with national standards and regulations.
5. Facilitated training sessions for staff on compliance and documentation best practices.
6. Monitored changes in regulations and communicated updates to the team to maintain compliance.
7. Utilized data analysis tools to generate reports that identify trends and areas for improvement in billing practices.

Experience

5-7 Years

Level

Senior

Education

B.S. H.I.M.

Description :

1. Conducted audits on medical claims, ensuring compliance with industry regulations.
2. Analyzed billing practices to identify discrepancies and enhance revenue integrity.
3. Provided actionable recommendations to improve documentation and billing accuracy.
4. Collaborated with healthcare providers to streamline billing processes.
5. Evaluated ICD and CPT coding for accuracy in acute care claims.
6. Assessed financial systems, recommending controls for data integrity.
7. Prepare detailed audit reports summarizing findings and recommendations.

Experience

0-2 Years

Level

Entry Level

Education

B.S. in HA

Description :

1. Performed audits on medical records to ensure compliance with healthcare regulations.
2. Analyzed billing data to verify accuracy and quality of patient care.
3. Conducted audits of patient medical histories in alignment with state laws.
4. Ensured quality assurance for medical and pharmaceutical supplies.
5. Collaborated with the FDA to ensure proper handling of controlled substances.
6. Managed the receipt and storage of controlled products, class A to C.
7. Audited shipments for compliance with quality assurance standards.

Experience

7-10 Years

Level

Management

Education

B.S. in HIM

Description :

1. Managed and coordinated organ/tissue donor cases with a focus on compliance and documentation accuracy.
2. Conducted audits on patient records to ensure adherence to healthcare regulations and quality standards.
3. Collaborated with medical staff to gather information for accurate record-keeping and compliance verification.
4. Prepared detailed reports outlining audit findings and recommendations for process improvements.
5. Implemented corrective actions for identified discrepancies, enhancing overall record integrity.
6. Utilized strong analytical skills to assess the quality of patient care through comprehensive audits.
7. Trained staff on best practices in documentation and compliance, fostering a culture of accuracy.

Experience

7-10 Years

Level

Management

Education

BSHIM

Description :

1. Assigned diagnostic and procedural codes to patient records using ICD-10-CM and CPT in accordance with coding guidelines.
2. Reviewed medical records against billed procedures to ensure accuracy of coding and compliance.
3. Provided feedback on documentation improvement opportunities to physicians and clinical staff through onsite visits and teleconferences.
4. Generated detailed audit reports and educational materials for staff reference and compliance adherence.
5. Assisted practice managers with administrative tasks while maintaining a focus on audit requirements.
6. Demonstrated strong attention to detail and sound decision-making in independent audit tasks.
7. Conducted comprehensive audits of patient accounts to ensure billing accuracy and compliance.

Experience

2-5 Years

Level

Management

Education

BSHIM

Description :

1. Managed daily operations of the clinic, ensuring compliance with medical record standards.
2. Scheduled appointments and coordinated communication between patients and counselors.
3. Prepared and organized patient charts for upcoming appointments, maintaining accuracy.
4. Created new patient charts with detailed information, including allergies and flags.
5. Processed medical record requests from external physicians and maintained confidentiality.
6. Assisted in conducting audits and training staff on proper documentation practices.
7. Prepared daily reports for the Director of Nursing regarding compliance and documentation issues.

Experience

2-5 Years

Level

Executive

Education

B.S. in HIM

Description :

1. Maintained comprehensive records and data logs while investigating and resolving billing, coding, and medical necessity discrepancies.
2. Consistently exceeded performance expectations by surpassing daily audit quotas.
3. Collaborated effectively in teams and independently to meet management goals.
4. Conducted thorough audits of medical records for required documentation, preparing detailed reports of findings.
5. Supported the appeal process, preparing claims for Redetermination, Reconsideration, and ALJ hearings.
6. Researched and analyzed audit inquiries, performing both claim and medical record reviews.
7. Identified and addressed documentation gaps to enhance compliance and operational efficiency.

Experience

2-5 Years

Level

Executive

Education

BSHIM