Medicare OPPS Coding Audit Manager

Description

Do you want to join an organization that invests in you as a Medicare OPPS Coding Audit Manager? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  
  
• Fertility and family building benefits through Progyny
  
  
• Free counseling services and resources for emotional, physical and financial wellbeing
  
  
• Family support, including adoption assistance, child and elder care resources and consumer discounts
  
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
  
• Employee Stock Purchase Plan
  
  
• Retirement readiness and rollover services and preferred banking partnerships
  
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
  
• Colleague recognition program
  
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
  

Note: Eligibility for benefits may vary by location.

You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Audit Manager like you to be a part of our team.

During your time as a Medicare OPPS Coding Audit Manager you will assist on ensuring claims are coded and billed in compliance with CMS regulations and HCA Healthcare Policies and Procedures. The Coding and Billing Compliance team is responsible for completion of coding and billing audits for hospital outpatient and ambulatory surgery center (ASC) settings.

What you will do in this role:

• You will perform Medicare OPPS coding/billing audits and project reviews.
• You will demonstrate a thorough understanding of complex Medicare OPPS coding and billing concepts, (including CPT, ICD-10, HCPCS), and auditing concepts; discusses complex coding and auditing issues with engagement team and client management; keeps informed of professional standards and company/department policies and procedures and effectively applies this knowledge to complex client situations.
• You will manage work of seniors and Staff.
• You will manage audit engagements - including managing their individual time; scheduling and assigning work and monitoring the progress of audit fieldwork; and proposing modifications to current procedures to improve audit effectiveness and efficiency.
• You will prepare semi-annual and annual performance evaluations for assigned mentees.
• You will communicate the objectives of a review and planned other services to the client engagement team and establishes/communicates team members' roles in the process.
• You will stay abreast of general industry, regulatory and economic developments and applies their understanding to identify areas of audit significance.
• You will assess the degree of risk and the nature of the errors that could result from coding and billing errors, identifies unusual or unexpected transactions and processes, and demonstrates a broader understanding by recognizing business trends and emerging technical and industry developments of relevance to share with the client engagement team.
• You will serve as a trusted business advisor by providing the client advice.
• You will provide input and guidance in the development of, as well as the review of, the detailed audit/review programs and Interim Summary and Memorandum.
• You will execute audit procedures in complex, judgmental and specialized areas of outpatient coding and billing.
• You will analyze evidence, reach conclusions, identifies issues and proposes strategies for complex, judgmental issues, as well as makes decisions related to moderately complex issues with regard to the review procedures executed. Consults with others in the Company, as necessary, on complex issues.
• You will review working papers and memoranda prepared by Staff and Seniors for technical accuracy and completeness, as is consistent with generally accepted auditing standards, as well as the requirements of the department.
• You will utilize and encourage the application of department computer-based audit tools.
• You will prepare and deliver presentations to engagement team members (e.g. when conducting planning meetings) and client management (e.g., when participating in closing conferences).
• You will prepare memoranda, working papers, and other documents in conjunction with serving the client (e.g. proposals, engagement letters, management letters, and other reports).
• You will develop and maintain working relationships with client management and demonstrates a commitment to identify client needs and continually improve our client's satisfaction.
• You will provide guidance to assist Staff and Seniors in reaching their full potential (e.g., willingly addresses questions, contributes constructive on-the-job feedback and training, conducts meaningful and timely performance reviews) and assists them in designing and implementing individual development plans.
• You will foster teamwork by maintaining cooperative relationships with client engagement teams (e.g. sharing Staff's and Senior's time with other engagement teams), contributing to positive work environments, facilitating the resolution of conflicts, sharing information, and accepting and providing constructive feedback.
• You will understand the full range of department services and identifies ways to address the needs of the client.
• You will maintain an education program to continually develop technical coding, HIM, auditing and management skills consistent with the department's professional development requirements.
• You will assist with other educational and administrative matters (e.g. professional development programs, process improvement team initiatives, recruiting efforts, and special projects).

What qualifications you will need:

• 6-8 years of experience (Medicare OPPS Coding preferred)
• College Graduate
• Certified as a RHIA or RHIT, with CCS preferred
• Medicare OPPS Coding Experience preferred
• Charge master, claims processing and coding quality monitoring experience helpful
• Ability to travel up to 25%
• Remote or hybrid work schedule potential

HCA Healthcare (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Good people beget good people." - Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Medicare OPPS Coding Audit Manager opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.