Physician Billing Auditing Lead

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

K.S.A.'s:

• Minimum of associate degree is required.
• Coding credentials required such as RHIT, RHIA, CPC, CCS, or CCS-P.
• Requires 3-5 years coding work experience and additional auditing experience.
• Experience with pediatric, multi-specialty healthcare organization preferred.
• Previous experience with project management preferred.
• Demonstrates thorough knowledge of CPT and ICD-10-CM coding.
• Maintains a thorough understanding for medical record practices, standards, regulations, Joint Commission and Illinois Medicaid coding and reporting requirements.
• Demonstrates understanding of medical terminology, anatomy and physiology and coding classification systems and can apply this knowledge in determining appropriate physician coding.
• Demonstrates the ability to communicate effectively with providers, co-workers and managers.
• Demonstrates the ability to work independently and balance multiple priorities.
• Must be able to utilize coding resources (3M, Encoder Pro, NGS (National Government Services), NCCI, CPT Assistant, payer policies).
   

Job Duties:

• Maintains audit schedule and process for monthly and quarterly audits.
• Monitors auditor’s productivity by collaborating with the Auditing Manager to meet designated productivity. 
• Performs quality review to meet designated quality accuracy as outlined in the Coder/Auditor Quality and Education Policy.
• Reviews work queues daily to ensure encounters not needed for audit are submitted.
• Performs auditing functions as needed.
• Acts in the capacity of liaison to providers, managers and other coding team members.
• Trains new auditors on department policies and procedures. Trains new auditors on auditing software and EMR (Epic). Reviews auditing process with new coders.
• Resolves questions, issues, and patient disputes with third party payors, billing coordinators, compliance auditors, external billing company and denial management team that pertain to coding.
• Prepares department coding feedback based on trends and issues identified in audits and denials.
• Works with Coders, Coding Manager, Auditors, and Audit Manager to resolve denials, identify trends, and implement process improvements to increase clean claim rate and improve denial recovery rate.
• Collaborates with Auditing Manager to improve Charge Review work queues workflow through various work queues improvement initiatives.
• Collaborates with Auditing Manager regarding content for auditing bi-monthly meeting including preparing education materials, room reservation and other tasks requirements.
• Collaborates with Auditing Manager to perform and complete revenue cycle coding projects
• Develops and maintains division specific coding protocols for auditing purposes
• Assists Auditing Manager with employee time management on a weekly basis including staffing coverage.
• Assigns appropriate ICD-10-CM diagnosis code(s), CPT procedure codes and modifiers using coding conventions, guidelines, and payor specific requirements.
• Abstract and compile data from medical records for appropriate optimal reimbursement
• Works actively with providers and coders to initiate corrections and resolve discrepancies in coding and documentation.
• Works collaboratively with providers to assure accurate and timely submission of claims related to auditing.
• Provides feedback at division meetings around documentation and coding trends identified by audit. 
• Submits help desk tickets and system change requests for coding and collaborates with IM for resolution
• Provides regular communication and education to providers and other clinical teams as indicated.
• Performs job junctions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
• Performs other related duties as assigned.
   

Education

Pay Range

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical, dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO), Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

• Supplemental Life, AD&D and Disability
• Critical Illness, Accident and Hospital Indemnity coverage
• Tuition assistance
• Student loan servicing and support
• Adoption benefits
• Backup Childcare and Eldercare
• Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
• Discount on services at Lurie Children’s facilities
• Discount purchasing program

There’s a Place for You with Us

At Ann & Robert H. Lurie Children’s Hospital of Chicago and its affiliates (collectively “Lurie Children’s”), we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds, skills, and viewpoints — recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging and allyship. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.  

Lurie Children’s and its affiliates are equal employment opportunity employers.  We value diversity and are committed to creating an inclusive environment for all employees.  All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law. 

For questions about how to request an accommodation please contact: [email protected]

AI Notice 

Lurie Children’s utilizes certain AI-enabled features within our recruiting platform to support candidate engagement and assist recruiters in identifying and prioritizing applicants whose experience aligns with job requirements. All employment decisions are made by individuals.

It is a civil rights violation with respect to recruitment, hiring, promotion, or employment for an employer to use artificial intelligence that has the effect of subjecting employees to discrimination on the basis of protected classes under the Illinois Human Rights Act or to use zip codes as a proxy for protected classes.

For questions about the use of artificial intelligence in this process or any additional support, please contact: [email protected]