What are the responsibilities and job description for the Payor Audit Documentation Specialist position at Mercy?
We’re a Little Different
Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.
At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”
Overview:
The Payor Audit Documentation Specialist is responsible for performing a thorough review of all documentation prior to submission of the Audit Response Packet and for preparing and submitting appeals as required. This position will work closely with all those co-workers directly involved in the audit and appeal process.
Qualifications:
- Education: High school diploma or equivalent certification.
- Experience: A minimum of two years’ experience with healthcare coding (CPT, HCPCS, DRG, IDC-10, HIPPS, RUG, Modifiers, Revenue Codes, etc.) and appeals process.
- Required Certifications: Certification must be obtained within six months of hire in one of these areas: Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and/or Registered Health Information Technician (RHIT).
- Preferred Education: Bachelor’s degree in a related field.
- Preferred Certifications: Current certification in one of the required areas. Certification in Healthcare Compliance (CHC), Certified Revenue Cycle Representative (CRCR), Registered Health Information Administrator (RHIA)
OTHER SKILLS & KNOWLEDGE:
- Knowledge of regulatory and payer requirements for reimbursement and reason(s) for denials by auditors.
- Knowledge of Medicare NCD & LCD guidelines
- Coding and/or Health Information Technician background
- Ability to critically evaluate and make decisions about whether appeals should be made based on reviews of patient medical records or procedures completed.
- Skill in writing convincing appeals arguments that is sound and supported by evidence that is related to patients' specific clinical attributes.
- Excellent oral and technical writing and typing skills.
- Ability to stay current on changing governmental regulations related to healthcare reimbursement.
- Excellent interpersonal, communication and organizational skills to effectively work with others involved in the audit and appeal process.
- Must possess the ability to prioritize, delegate, and organize various tasks/projects simultaneously to ensure departmental and Mercy-wide goals are timely met.
- Demonstrates personal qualities such as kindness, compassion, understanding, integrity, interest and respect for others.
- Ability to maintain confidentiality when working with sensitive information.
- Knowledge of computer applications and their implications on the audit and appeal process.
- Ability to work independently to accomplish and carry out goals/objectives in a collaborative manner.
- Very high personal integrity and work ethic with the ability to demonstrate and obtain.
- Ability to travel periodically across the Ministry as required.
We Offer Great Benefits:
Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!
We’re bringing to life a healing ministry through compassionate care.
At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all.
What Makes You a Good Match for Mercy?
Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and unafraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.
EEO/AA/Minorities/Females/Disabled/Veterans
Coding, healthcare coding, HIT, CPC
