The Encounter Documentation Auditor is responsible for performing audits of office-based encounters to assess the accuracy and integrity of the electronic billing process, preparing comprehensive reports on the results of coding and billing audits, denial trends, and areas for improvement of clinical documentation, and meeting with providers and clinical staff to provide education and present results of audits.
Job Relationships
Reports to the Billing Compliance Manager
Principal Responsibilities
Perform scheduled audits of office-based services with special emphasis on assessment of Evaluation and Management levels assigned to encounters, identifying missed billing opportunities and errors in assignment of CPT codes.
Develop audit schedule in collaboration with the Patient Accounting Director and Billing Compliance Manager.
As directed, study potential reimbursement issues or financial impact of improper billing identified in audits.
Prepare formal reports documenting audit findings and educational material for distribution to Operations management and providers.
Maintain a comprehensive log of all audits performed.
Report all concerns of possible non-compliance in billing matters to the attention of the Patient Accounting Director and Billing Compliance Manager.
Assess results of denial/edit data towards producing a comprehensive audit report on an individual provider basis
Analyze clinical documentation to identify areas of potential improvement especially as it pertains to the conversion to the ICD-10 code set.
Maintain a strong working knowledge of Evaluation and Management
and CPT coding, as well as the ICD-10 code set.
Comply with the Springfield Clinic incident reporting policy and procedures.
Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
Provide excellent customer service and adhere to SC Way customer service philosophy.
Perform other job duties as assigned.
Education/Experience
High School graduate or GED required; college degree preferred.
Minimum of three (3) years coding, clinical billing or auditing experience preferred.
Must possess some combination of coding (certified coder preferred), clinical office experience and/or billing audit experience.
Proficiency with the Clinic's practice management system (IDX), electronic health record (Touchworks), and Microsoft Office suite.
Knowledge, Skills and Abilities
Ability and desire to further knowledge of laws/regulations/coding expertise by continuing education efforts (reading manuals/subscriptions/newsletters, attending in-services and educational conferences).
Ability to work independently on assigned duties with minimal supervision.
Must possess strong analytical and communication skills.
Must possess manual dexterity required for use of computer keyboard.
Working Environment
Requires sitting and standing for periods of time working in an office environment.
Some amount of travel to clinical locations, typically locally, required.
PHI/Privacy Level
HIPAA1
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