Provider Educator Auditor

Summary:

Responsible for training in CPT assignment for on-boarding physicians and mid-level providers; Auditing new providers as described per policy and re-educating as needed. Audit and educate coding staff as necessary. Reviewing and validating a variety of charges generated from the providers. Performs in accordance with the policies and procedures. Follows standards for ethical business conduct. Conducts self as a positive role model and team member. Participates in facility committees, meetings, in-services, and activities as requested.

Key Responsibilities:

• Collaborate with other departments to resolve billing problems related to coding, including those stemming from CCI edits and the outpatient code editor (OCE).
• Perform coding, documentation, and billing audits in focus areas as assigned, including summarizing audit findings, and proposing recommendations. Oversee implementation of audit recommendations as appropriate.
• Perform follow-up audits and reviews to monitor and validate ongoing compliance with applicable rules and guidelines.
• Maintain excellent intradepartmental communication; maintain good rapport with Practice Management and other departments and employees throughout Steward.
• Educate practices/providers on basic coding, documentation, and billing issues related to appropriately charging for, and documenting the services delivered in compliance with applicable rules and regulations.
• Educate key stakeholders on significant matters related to coverage decisions, coding issues, and new or revised regulations.
• Based on experience and industry knowledge, make recommendations to streamline processes related to accurate and appropriate revenue capture for services performed, ensuring compliance with all appropriate regulations and guidelines.
• Complete required continuous training and education, including department specific requirements.
• Maintains certifications and stays current on industry trend.

Knowledge and Skills:

• Experience utilizing Microsoft Office required.
• Experience should include thorough knowledge of health care operations, physician practice reimbursement including RVUs, charging practices, governmental coding requirements including extensive knowledge of CPT / HCPCS / ICD and modifiers, and healthcare financial systems.
• Experience in researching, interpreting and applying Medicare, Medicaid, MASSHEALTH, and other third party payer regulations is essential.
• Superior analytical skills, excellent writing, organizational and interpersonal skills.
• Demonstrated highly developed project management skills, along with excellent problem solving and analytical skills, and verbal and written communication skills.

Education and Experience:

• Bachelor's degree is strongly preferred.
• 3+ years of related work experience is preferred.
• CPC or CCS-P required. Certification of healthcare compliance (CHC) strongly preferred.

About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.


As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.



For more information, visit www.steward.org.

Steward Health Care is proud to be a minority, physician owned organization. Diversity, equity, inclusion and belonging are at the foundation of the care we provide, the community services we support and all our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.