Billing Auditor

Full-time Description Billing Auditor Buffalo, Rochester, or Syracuse, NY

Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment. No matter what.

In support of PPCWNY’s mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for improvement to Revenue Cycle leadership in the planning, implementation, and management of the operations and daily workflows of the Revenue Cycle team. The Billing Auditor works collaboratively with the Revenue Cycle Leadership Team to ensure established workflows and procedures are implemented, to support Billing and Collections integrity and ensure revenue cycle goals are achieved.

The Revenue Cycle Billing Auditor also works closely with staff and Planned Parenthood stakeholders to establish and maintain collaborative relationships to accomplish strategic Revenue Cycle objectives across departments and multiple affiliates in Shared Services.

70% Auditing and Corrective Action

• Evaluates charge capture, claims scrubbing and sliding fee discount practices to ensure efficiency, accuracy, and completeness of encounters, claims and transactions in compliance with payer rules and regulations
• Maintains and ensures a disciplined and effective approach to discover root causes of denials, under billing, overbilling, underpayment, and aging A/R
• Reports to Revenue Cycle Management, Affiliate HS/RC Monthly meetings, and Quality Risk Management Committees on trends, findings, and opportunities for improvement detailing findings and high-risk items that leaders should be monitoring
• Develops and recommends corrective action plans including work queues which identify and sequence the activities needed to ensure that identified issues are resolved accurately and in a timely manner to meet deadlines
• Recommends modifications to established practices and procedures or system functionality based on findings to improve workflows, to standardize processes and maximize reimbursement

30% Collaborative Problem Solving and Reporting

• Supports the documentation and maintenance of Revenue Cycle Standard Operating Procedures (SOPs)
• Supports the documentation of Revenue Cycle training materials and presentations
• Works collaboratively with the Revenue Cycle Leadership to ensure effective, consistent, and timely communication across affiliates
• Builds and manages relationships with Payers to identify and resolve claim billing and processing issues
• Works collaboratively within Revenue Cycle and with other stakeholders across departments and affiliates utilizing both verbal and written communication to improve Revenue Cycle outcomes
• Manages individual projects as assigned and provide weekly status reports
• Performs data processing, analysis and reporting of Revenue Cycle activities and metrics with supporting detail

• Attends and participates in team meetings, and other required meetings or training opportunities
• Performs other duties as assigned
• Handles confidential and non-routine information with sensitivity
• Practices a customer-oriented and team approach in carrying out job responsibilities
• Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs

Education

• Bachelor’s degree in Business or Healthcare Administration or related field preferred
• Certified Professional/Medical Coder or Certified Professional Medical Auditor desired

Experience

• Minimum 3 years of experience in medical billing and collections, including follow-up on unpaid claims, researching insurance claims issues, and appealing to insurance companies for denied claims within standard billing cycle time frames
• Minimum 3 years of experience with computerized billing/receivables system and reports
• Experience with Next Gen practice management system preferred
• In-depth knowledge of Governmental and non-Governmental insurance guidelines and other healthcare funding programs
• In-depth knowledge of ICD, CPT, and HCPCS coding as well all billing,…