Chart Auditor - Coder

Description A Hospital in Los Angeles is in the need of Chart Auditor. The Chart Auditor is responsible for validating, clearing, and finalizing DNB edits either in the PFS host Patient Accounting system or claims editing system. At times, the Chart Auditor may conduct insurance audits with designated payer auditor per contractual terms. The Chart Auditor may also be responsible for hospital department communication including disputed charges, charge capture, and or pending supporting documentation. Essential Duties Responsible for interacting with hospital departments including the PFS Business Office, and or insurance/payers on audits, disputed charges and hospital billing and charging problems. Communicate with hospital department directors on a weekly or as needed basis on outstanding or missing documentation or charging issues. Completes charge audits or billing edits as necessary in a timely and accurate manner. Assists with training for new hires or contract/contract staff. Complies with Hospital guidelines. Communicates with, insurance companies or auditing services to resolve complaints or defense audits. Completes department charge master updates and department requests timely and accurately. Communicates with hospital departments as needed regarding billing, charging, and documentation problems. Finds solutions to existing charging problems. Schedules and conducts high dollar amount defense audits of patient medical records with insurance company representatives to verify documentation to support hospital Completes charge corrections and coordinates necessary re-bills based on agreed audit results. Validates and manages bill holds relating to charge reviews held by Risk Management. Coordinates approvals with Risk Management and bill release process. Conduct concurrent or focus audits to validate charge capture audits on randomly selected accounts monthly to identify charging issues which may indicate deficiencies in charge pathways and processes and target specific departmental issues. Consistently and thoroughly work DNFB and PFS claim edits work lists to ensure timely completion within hospital policies and monthly goals. Assists and supports the Director of Revenue Analysis and Director of A/R Management as assigned. Requirements Pref Specialized/technical training Graduate from an accredit program in one of the following areas: LVN, RN, Certified Coding Specialist or detail oriented Coder. Pref 1 year Experience in medical auditing or HIM coding preferred

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