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Provider Services Auditor

St. Luke's Health Network, Inc.

Allentown, PA

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Accounting, Analysis Skills, Auditing, Billing, Billing Software, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Communication Skills, Current Procedural Terminology (CPT), Data Analysis, Data Management, Documentation, Federal Laws and Regulations, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Providers, High School Diploma, ICD-9, Interpersonal Skills, Material Moving, Medicaid, Medical Coding, Medical Records, Medicare, Microsoft Excel, Nursing, Presentation/Verbal Skills, Primary Care, Professional Services, Record Keeping, Regulatory Requirements, Reporting Skills, State Laws and Regulations, Systems Administration/Management, Third-Party Payer, Training/Teaching, Writing Skills
LOCATION
Allentown, PA
POSTED
13 days ago
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for professional services billed by providers employed with St. Luke’s Physician Group (SLPG). In doing so, works with providers and their office staff, as well as the Coding and SLPG Billing Department. JOB DUTIES AND RESPONSIBILITIES:Perform quality audits to include reviewing medical record documentation for completeness and accuracy to support billed claims.Generate provider reports through billing software.Coordinates, schedules, and meet with providers to perform education for the professional service documentation and coding audits of both office and in-patient medical records.Maintain and record audits in Excel spreadsheet format and through an auditing software program.Is a resource to the coding department, SLPG practices, providers, and billing department.Assisting with the development of training materials for compliance education and training modules. Provides training classes to new providers throughout the year along with providing education to the Residency programs.Maintain current knowledge of coding and documentation educational updates for primary care and specialty services.Assists in the formulation and review of Network policies and guidelines affecting the coding of professional services.Assists in maintaining the FY audit plan and accurate accounting of time allocated to each audited provider.Analyzing data in Excel or other software programs and making sound recommendations based on the results. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for up to eight hours per day. Driving distances up to 50 miles one way. Must possess hearing, seeing, speaking and reasoning senses necessary to carry out job duties. Occasional lifting/carrying of objects such as office supplies, files, etc. with maximum of ten pounds. Walking, bending, twisting and reaching necessary to carry out duties of job. EDUCATION AND TRAINING: High school diploma or equivalent required. Certification of CPC, CCS, or CCS-P highly desired OR Coding certification within one year. Working knowledge of ICD-9, CPT, and HCPCS coding required. TRAINING AND EXPERIENCE: At least 2 years of healthcare experience with background and competency in coding and documentation State and Federal regulatory requirements including Medicare, Medicaid and third-party payers as well as strong written/verbal communications skills preferred. Strong computing and data management abilities, analytical, and interpersonal and communication skills which are all essential skills. Microsoft office skills to include word, Excel and Power Point Presentations Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!St. Luke's University Health Network is an Equal Opportunity Employer.

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St. Luke's Health Network, Inc.

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