How have you impacted someone’s life today? At Hackensack MeridianHealthour healthcare teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career all within New Jersey’s premier healthcare system.
The Medical Auditor is capable of working independently on audits by reviewing details of the medical record and reconciles that information to the itemized bill. In addition, the person in this position performs reviews involving outpatient and managed care billing/reimbursement.
A day in the life of Medical Auditor at Hackensack Meridian Health includes:
- Performs inpatient and same day surgery concurrent reviews, reconciles details of the medical record with the itemized bill line by line. Enters credits and debits into Epic, based upon audit results. Confirm credits and debits downloaded from Epic into Audiman are correct. Adds comments into Audiman as needed.
- Confirms pricing with vendors when necessary.
- Reviews outpatient accounts (Adult Oncology, Radiology, Cardiac Cath Lab, etc.) for billing and documentation errors.
- Reviews Observation, No-fault outpatient and Medicare Emergency Room accounts for documentation and billing accuracy. Submits the results to Health Information Management for correction if needed.
- Investigates and responds to Patient Accounting/Business Office inquiries (and patient inquiries via the Patient Accounting) regarding the accuracy of the bills with regard to the services provided.
- Separates charges of the shared patient services for Patient Accounting to bill appropriately.
- Separates out charges for procedures not approved by Medicare.
- Assists with defending HackensackUMC's charges/bills during insurance company audits. Provides documentation as needed to support billed charges. Refers utilization issues to the Utilization Review Department Conducts exit interviews.
- Monitors various reports for billing accuracy and Medicare Compliance.
- Educates nursing and other departments on proper documentation and billing.
- Investigates billing issues to determine the root cause and provides solutions, if possible to rectify the billing issue.
- Retrieves implant invoices from PeopleSoft for Patient Financial Services or authorized collection vendor.
- Adheres to the American Nurses Association stand
Education, Knowledge, Skills and Abilities Required:
- Associates level degree or equivalent.
- Advanced computer skills and be proficient at word/excel.
- Must possess basic math skills and be able to work well with numbers.
- Must have high level of accuracy and be detail oriented.
- Excellent problem solving and negotiation skills.
- Ability to deal with highly sensitive and confidential information and adhere to data security and HIPAA confidentiality procedures.
Education, Knowledge, Skills and Abilities Preferred:
- Bachelors of Science in Nursing (BSN).
- Experience working in the OR.
- Minimum 1 year of auditing experience, preferably with a health care organization or insurance company.
- Working knowledge of patient diagnoses, procedures, and equipment, along with the corresponding billing coding and documentation standards.
- Proficient in Word, Excel and Outlook.
- Prefer Knowledge of Clinical software e.g., SoftMed, Epic (Electronic Medical Record) and workbench (Epic) reporting desirable.
Licenses and Certifications Required:
- NJ State Professional Registered Nurse License.
If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!
Hackensack Meridian Health (HMH) is a Mandatory COVID-19 and Influenza Vaccination Facility
As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.