Description

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve.

Auditor, Payment Integrity Responsibilities:

1.     Validate the accuracy and integrity of inpatient and outpatient claims submitted for payment.

2.     Ensure code assignment is consistent with ICD-10-CM/PCS coding guidelines, AMA CPT guidelines, and clinical validation criteria.

3.     Perform medical chart reviews to validate the DRG. Provide coding guidelines and detailed clinical rationale to support any DRG change.

4.     Ensure provider billing adherence to medical policies and claims payment policies.  

5.     Interact with the provider to clarify clinical issues, documentation, and billing practices.

6.     Initiate, verify, and reconcile claim adjustments.  Maintain audit documentation.

7.     Evaluate algorithms, review data sets, independently solve problems, and research data anomalies.  Track audit trends

8.     Perform other duties of Auditors as required.

Qualifications:

•    Bachelor's degree in a health care-related field with one or more of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or CCS (Certified Coding Specialist).   

•   Proficiency in medical terminology and clinical reasoning.  

•    Strong critical thinking and analytical skills. 

•    Strong knowledge of ICD-10-CM and ICD-10-PCS coding guidelines. 

•    Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements, and/or Outpatient Prospective Payment System (OPPS).

•    Medical Chart Review experience is required.   

•    Excellent communication skills: verbal and written. 

•    Intermediate knowledge of MS Office: Excel, Word, Outlook.

Requirements

Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app.