Provider Educator / Auditor

Location: Steward Medical Group - North

Posted Date: 6/14/2021

POSITION SUMMARY:
Responsible for training in CPT assignment for on-boarding physicians and mid-level providers; Auditing new providers as described per policy and re-educating as needed. Audit and educate coding staff as necessary. Reviewing and validating a variety of charges generated from the providers. Performs in accordance with the policies and procedures. Follows standards for ethical business conduct. Conducts self as a positive role model and team member. Participates in facility committees, meetings, in-services, and activities as requested

RESPONSIBILITIES:

• Collaborate with other departments to resolve billing problems related to coding, including those stemming from CCI edits and the outpatient code editor (OCE).
• Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings, and proposing recommendations. Oversee implementation of audit recommendations as appropriate.
• Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
• Maintain excellent intradepartmental communication; maintain good rapport with Practice Management and other departments and employees throughout Steward.
• Educate practices/providers on basic coding, documentation, and billing issues related to appropriately charging for, and documenting the services delivered in compliance with applicable rules and regulations.
• Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations.
• Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines.
• Complete required continuous training and education, including department specific requirements.
• Maintains certifications and stays current on industry trend.

REQUIRED KNOWLEDGE AND SKILLS:

• Experience utilizing Microsoft Office required.
• Experience should include thorough knowledge of health care operations, physician practice reimbursement including RVUs, charging practices, governmental coding requirements including extensive knowledge of CPT / HCPCS / ICD and modifiers, and healthcare financial systems.
• Experience in researching, interpreting and applying Medicare, Medicaid, MASSHEALTH, and other third party payer regulations is essential.
• Superior analytical skills, excellent writing, organizational and interpersonal skills.
• Demonstrated highly developed project management skills, along with excellent problem solving and analytical skills, and verbal and written communication skills.

EDUCATION/EXPERIENCE:

• Bachelor's degree is strongly preferred.
• 3+ years of related work experience is preferred.
• CPC or CCS-P required. Certification of healthcare compliance (CHC) strongly preferred.

Steward Health Care is the largest private, for-profit health care network in the United States. The company is owned and led by a management team of Steward physicians. Headquartered in Dallas, Texas, Steward employs more than 40,000 health care professionals and operates 35 hospitals across the United States and in the countries of Malta and Colombia which regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, more than 7,000 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.

The Steward Health Care Network includes more than 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters annually. Steward Medical Group, the company's employed physician group, provides more than six million patient encounters per year. The Steward Hospital Group operates hospitals in Malta, Colombia and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit www.steward.org.

Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.

Additional Information

Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.

1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
2. A stringent cleaning policy has been implemented throughout our facilities.
3. A strictly controlled visitor and mask policy is required for patient and colleague safety.