Location: Baltimore, Maryland
Internal Number: 109357-en_US
We are seeking a Sr. Billing Compliance Auditor who will provide oversight, training, guidance and assistance to Billing Compliance Auditors and Sr. Billing Compliance Auditors in the daily routine tasks of their position, under supervision of the Director. Collaborate with the Manager and Director to assure consistent quality performance amongst all Auditors. Responsible for balancing work load, assuring that responsibilities of the group are completed within established time frames and making recommendations to improve workflow, process and productivity. Provide input to and assist in performance evaluations and improvement actions.
Specific Duties & Responsibilities
Serves as a working lead, performing the job functions of a Sr. Billing Compliance Auditor/Trainer in addition to the following responsibilities:
- Trains or assists in the training of new Auditor/Trainers to ensure uniformity and quality of work. This includes the performance of documentation reviews; conducting individual and group training sessions; using appropriate resources to research questions from providers and billing staff; and use of audit software.
- Meets regularly with the Auditors/Trainers to review the progress of work and address any impediments to meeting deadlines. Provides regular updates and presents issues that require management involvement to the Manager.
- Assigns work; balances work load; and adjusts priorities in consultation with the Director. With the Director input, sets productivity goals and quality standards for the Auditors/Trainers and produces and reviews reports to monitor progress.
- Assists in training physicians, other clinicians, billing office staff and others on the clinical documentation and coding requirements for professional fee billing.
- With the Manager and Director, establishes a protocol to collaboratively work with the CPA's Physicians Billing Service and JHHS's Compliance Office to investigate and resolve billing complaints, operational issues and/or errors that impact hospital and professional fee billing.
- Ensures the quality of the audit work and reports prepared by the Auditors/Trainers under his/her responsibility.
- Prepares and revises policies and procedures for the Auditors/Trainers.
- Performs other compliance related activities as necessary.
Scope of Responsibility
- Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division. Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.
- On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area. Routinely handles confidential patient information and sensitive financial information.
- Lead will train new staff in auditing processes and office procedures and review and correct the work of other Auditors/Trainers.
- Lead will assign and reassign work to assure reviews are completed on time, training is conducted and meetings are held as necessary.
- Auditors/Trainers may be asked to assist with training new staff or correcting the work of others. Identifies and suggests process and operational improvements.
- Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.
Special Knowledge, Skills & Abilities
- Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion. Must be able to learn quickly and work independently to address a variety of complex issues. Must be flexible to adjust to the development and refinement of new processes and procedures. CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others. Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. Knowledge of related clinical and business practices, policies, and procedures for billing and collection of professional fee services, and audit processes preferred. Demonstrated communication, analytical and organizational skills are essential.
- Demonstrated training or teaching experience required.
- Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage.
- Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems preferred.
- Must be self-motivated and comfortable working independently, as a team leader and as a team member.
- Sitting in a normal seated position for extended periods of time.
- Reaching by extending hand(s) or arm(s) in any direction.
- Finger dexterity required to manipulate objects with fingers rather than with whole hand(s) or arm(s), e.g., use of keyboard.
- Communication skills, using the spoken word.
- Ability to see within normal parameters, ability to hear within normal range and ability to move about.
This description is a general statement of required major duties and responsibilities performed on a regular and continuous basis. It does not exclude other duties as assigned.
- Bachelor's Degree in health care-related or business-related field. A minimum of one professional coding certification (CCS-P, CPC, RHIA or RHIT) required by start date. Additional coding certifications preferred
- Four years of auditing/billing compliance required. Minimum of five years preferred. Demonstrated training or teaching experience required.
- Recent, direct experience with third party payer requirements for physicians may substitute for some education. A master's degree in a health care related discipline may be substituted for up to one year of experience
Classified Title: Sr. Billing Compliance Auditor
Working Title: Sr. Billing Compliance Auditor
Starting Salary Range: $71,230 - $97,880 - $124,510 annually (commensurate with experience)
Employee group: Full Time
Schedule: M-F 8:30A-5P
Exempt Status: Exempt
Location: Hybrid/School of Medicine - East Baltimore Campus
Department name: SOM Admin CPA Billing Quality Assurance
Personnel area: School of Medicine
The referenced salary range is based on Johns Hopkins University's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/
Please refer to the job description above to see which forms of equivalency are permitted for this position. If permitted, equivalencies will follow these guidelines:
JHU Equivalency Formula: 30 undergraduate degree credits (semester hours) or 18 graduate degree credits may substitute for one year of experience. Additional related experience may substitute for required education on the same basis. For jobs where equivalency is permitted, up to two years of non-related college course work may be applied towards the total minimum education/experience required for the respective job.
**Applicants who do not meet the posted requirements but are completing their final academic semester/quarter will be considered eligible for employment and may be asked to provide additional information confirming their academic completion date.
The successful candidate(s) for this position will be subject to a pre-employment background check. Johns Hopkins is committed to hiring individuals with a justice-involved background, consistent with applicable policies and current practice. A prior criminal history does not automatically preclude candidates from employment at Johns Hopkins University. In accordance with applicable law, the university will review, on an individual basis, the date of a candidate's conviction, the nature of the conviction and how the conviction relates to an essential job-related qualification or function.
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