Billing and Coding Associate Auditor
: Job Details :

Position Details

Position Information

Recruitment/Posting Title Billing and Coding Associate Auditor Job Category Staff & Executive - Healthcare Department UFA-Univ Ethics & Compliance Overview

Rutgers, The State University of New Jersey, is a leading national research university and the State of New Jersey's preeminent, comprehensive public institution of higher education. As one of the largest employers in the State of New Jersey, Rutgers University is committed not only to the students and the State that we serve, but also to the faculty and staff who work on our campuses. Ranked in 2022 by Forbes as a top 100 best large employer in America, Rutgers' commitment to its employees includes maintaining and fostering a safe, diverse, and respectful workplace environment, creating employment opportunities for our nation's military veterans, and ensuring accessibility and accommodation for individuals with disabilities.

University, Ethics and Compliance (UEC) is committed to building an intentionally diverse, equitable and inclusive environment for all employees. We aim to collectively improve our understanding of the variety of personal experiences, values, and worldviews that arise from differences of culture and circumstance. UEC is actively working to identify and eliminate barriers to create a more equitable workplace for all. Our goal is to have an inclusive work environment in which all individuals and groups feel welcomed, respected, supported, and valued.

Posting Summary

Rutgers, The State University of New Jersey is seeking a Billing and Coding Associate Auditor for the University Ethics and Compliance department. Under the direction of the Director of Enterprise Risk Management and Healthcare Billing and Coding Audit, and the Billing and Coding Manager, this position is responsible for ensuring accuracy and compliance with federal, state and third-party payer rules and regulations governing proper documentation for Rutgers billing and coding practices. The Billing and Coding Associate Auditor provides professional, independent, and objective assessments of the healthcare professionals' services being audited which includes communicating those assessments by developing comprehensive reporting packages. This role is responsible for reviewing medical records, claims and other necessary documentation to ensure Rutgers healthcare professionals are adhering to coding guidelines and regulatory requirements. The Billing and Coding Associate Auditor conducts required training and education to provide guidance to individual providers and/or departmental/divisional groups based on audit findings, and participates in internal investigations, conducting billing and coding analyses when such expert knowledge is required.

Among the key duties of this position are the following

* Provides professional expertise in healthcare billing and coding by conducting timely risk-based audits to assist management in accomplishing workplan objectives.

* Assists in planning audits by identifying potential risk areas, reviewing applicable billing and coding guidelines, and examining departmental/divisional policies, procedures, and agreements.

* Reviews medical records and related documentation to assess the accuracy and completeness of billing and coding, identifying erroneous billing or discrepancies between billing and documentation.

* Assesses coding practices against industry standards, governmental regulations, and payer guidelines to ensure compliance.

* Communicates with the Director, CBM, and Lead Auditor throughout the audit to provide updates on progress, findings, and recommendations.

* Prepares draft reports of findings, including corrective action recommendations, for review by the Lead Auditor, CBM, or Director, with final approval by the Deputy Chief Compliance Officer or Chief University Compliance Officer before issuing to department/division administrators.

* Issues final reports upon completion of the exit meeting and receipt of management's response.

* Assists in developing and delivering training programs for Rutgers healthcare professionals on billing and coding regulations, ensuring compliance with policies and retraining providers when necessary, with timely post-education audits.

* Performs other tasks, including developing training materials for the University community in collaboration with UEC Compliance Officers, General Counsel, Labor Relations, and Employment Equity on topics such as federal and state law, University policies, and collective negotiations agreements.

* Assists in ensuring timely submission of written management responses for final report issuance and evaluating the adequacy of corrective actions.

* Works with the Lead Auditor to develop options for addressing corrective actions and monitoring their progress to ensure risks are mitigated.

* Provides expertise to the UEC Investigation unit by conducting billing and coding analyses to assess the validity of allegations and supplying necessary documentation and findings to the assigned investigator. If serving as Lead Investigator, preparing the Investigation Report for review and approval.

* Keeps leadership informed of status, findings, and observations.

* Maintains coding certifications and staying current with changes in coding standards, regulations, and Rutgers' policies through industry associations offering courses, webinars, and articles.

* Performs other duties as assigned.

Position Status Full Time Hours Per Week Daily Work Shift Work Arrangement FLSA Exempt Grade 05 Position Salary Annual Minimum Salary 69031.00 Annual Mid Range Salary 87377.00 Annual Maximum Salary 105722.00 Standard Hours 37.50 Union Description Admin Assembly (MPSC) Payroll Designation PeopleSoft Benefits

Rutgers offers a comprehensive benefit program to eligible employees. For details, please go to

Seniority Unit Terms of Appointment Staff - 12 month Position Pension Eligibility ABP

Qualifications

Minimum Education and Experience

* Bachelor's Degree, preferably in business administration, healthcare administration, health information management or other related field.

* Two (2) years of experience in a healthcare billing and coding role, and as a healthcare auditor.

Certifications/Licenses

* Certified Professional Coding (CPC) or Certified Coding Specialist Physician (CCS-P) and/or related certification).

* A valid driver's license would be required for this position; Use of personal vehicle in order to travel for business demands.

Required Knowledge, Skills, and Abilities

* Experience with medical record review.

* In-depth understanding of medical terminology, anatomy, physiology, and coding classification systems (ICD-10, CPT, HCPCS).

* Strong foundational understanding of HIPAA regulations.

* Awareness of, understand and interpret the policies, rules, regulations, laws, and statutes pertaining to the engagement.

* Well-versed in federal, state, and other third-party billing and coding regulations within the healthcare industry to ensure the institution is appropriately billing governmental (Medicare & Medicaid) and third-party insurers.

* Strong analytical and critical thinking skills.

* Focused attention to detail and accuracy in reviewing medical records and billing documentation.

* Competency in understanding and interpreting trends, relationships, and problems from statistical data.

* Proficiency in applying Billing and Coding guidelines and regulations specific to individual audit assignment.

* Ability to identify the appropriate audit technique for use depending on the circumstances of their assignment.

* Demonstrated effective teaching skills when providing training to healthcare professionals applicable to Billing and Coding guidelines.

* Strong writing skills to write professional audit reports, letters, emails, workpapers and other service communications.

* Proficiency in using electronic health records (EHR) systems, coding and auditing software, and Microsoft Office Applications.

* Skills in using personal computer hardware and software.

* Capability to capture business processes, information and communication flows, and internal control systems, for analysis and evaluation to appropriately apply audit procedures. This work often involves reading, interpreting, and/or gaining an understanding of vast amounts of documentation, including, but not limited to: federal, state, and local statutes; administrative codes; federal and state agency mandates; contracts with external organizations; and university and departmental policies and procedures, and systems documentation.

* Excellent listening skills so that engagements serve clients' needs, while achieving the objectives of University Ethics and Compliance and the university.

* Ability to research updates and changes to billing and coding regulations.

* Clear and professional communications skills.

* Strong computer skills to prepare reports, create spreadsheets, and utilize various data analytics, navigate various EHR systems and audit management software.

* The Associate Auditor should also be able to research the web.

* Self-discipline to progress on concurrent work assignments and tasks.

* Ability to make professional and supportable judgments on every assignment.

* Willingness to take direction from the Lead Auditor and University Ethics and Compliance management team.

* Commitment to high ethical standards, integrity, and a commitment to maintaining confidentiality and compliance in all aspects of work.

Preferred Qualifications

* Recent healthcare auditing experience.

* Experience working in an academic medical institution.

* Willingness to travel between campuses.

Equipment Utilized

* MDaudit EnterpriseVarious.

* EHR systems including Epic, Insight, Vista, Axium, Medaptus.

Physical Demands and Work Environment Special Conditions

* Clean Driving Record.

Posting Details

Posting Number 24ST2530 Posting Open Date 10/29/2024 Special Instructions to Applicants Regional Campus Rutgers University-Newark Home Location Campus Rutgers University-Newark City Newark State NJ Location Details

Pre-employment Screenings

All offers of employment are contingent upon successful completion of all pre-employment screenings.

Immunization Requirements

Under Policy 100.3.1 Immunization Policy for Covered Individuals, if employment will commence during Flu Season, Rutgers University may require certain prospective employees to provide proof that they are vaccinated against Seasonal Influenza for the current Flu Season, unless the University has granted the individual a medical or religious exemption. Additional infection control and safety policies may apply. Prospective employees should speak with their hiring manager to determine which policies apply to the role or position for which they are applying. Failure to provide proof of vaccination for any required vaccines or obtain a medical or religious exemption from the University will result in rescission of a candidate's offer of employment or disciplinary action up to and including termination.

Affirmative Action/Equal Employment Opportunity Statement

It is university policy to provide equal employment opportunity to all its employees and applicants for employment regardless of their race, creed, color, national origin, age, ancestry, nationality, marital or domestic partnership or civil union status, sex, pregnancy, gender identity or expression, disability status, liability for military service, protected veteran status, affectional or sexual orientation, atypical cellular or blood trait, genetic information (including the refusal to submit to genetic testing), or any other category protected by law. As an institution, we value diversity of background and opinion, and prohibit discrimination or harassment on the basis of any legally protected class in the areas of hiring, recruitment, promotion, transfer, demotion, training, compensation, pay, fringe benefits, layoff, termination or any other terms and conditions of employment. For additional information please see the Non-Discrimination Statement at the following web address:

Supplemental Questions

Required fields are indicated with an asterisk (*).

* * Do you have a Bachelor's Degree, preferably in business administration, healthcare administration, health information management or other related field?

* Yes

* No

* * Do you have at least two (2) years of experience in a healthcare billing and coding role, and as a healthcare auditor?

* Yes

* No

Applicant Documents

Required Documents

* Resume/CV

Optional Documents

* Cover Letter/Letter of Application

* List of Professional References (contact Info)