Under the direction of the Clinical Billing Integrity (CBI) Manager, this position performs daily activities required to fulfill the goals, audit plans, work plans, initiatives, and duties of the Integrity Program with a specific focus on billing, coding and documentation.
The CBI Analyst conducts audits and investigations, analyzes data, prepares reports, and participates in the development and implementation of follow-up education, outreach, and/or other corrective actions. This position also assists in the development of the Annual CBI Audit Work Plan that addresses future and ongoing compliance risks.
- Extensive knowledge of billing requirements, ICD-9-CM (diagnosis), CPT and HCPCS coding principles and guidelines
- Excellent oral and written communication skills including the ability to present findings and recommendations effectively
- Proficiency with electronic medical record systems, databases and related automated systems. CERNER (ORCA), EPIC, COGNOS and Mede-Analytics are a plus.
- Coding, documentation and reimbursement content area expertise in one or more of the following: utilization management, medical necessity, inpatient coding, or outpatient coding.
- Proficiency with MS Office applications (Excel, Word, Outlook, PowerPoint)
- Strong critical thinking and data analysis abilities. Demonstrated attention to detail.
- Comprehensive knowledge of federal and state regulations related to documentation, coding and billing
- Ability to independently prioritize and organize work efficiently
- Knowledge of research billing and/or research compliance requirements
- Demonstrated proficiency in project management and tools
- Excellent organizational skills
- Knowledge of software tracking mechanisms for compliance issues
- Experience with report generation for analyzing and presenting data
- Ability to develop and maintain collaborative working relationships with all departments involved in the audit and investigation process
- Ability to collaborate with others in seeking resolutions of problems
- Ability to exercise strict confidentiality with all aspects of the position
- Ability to gather information from multiple sources in order to gain a thorough understanding of problems/issues under investigation
- Facility billing experience
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