Position Summary:

• Provides professional expertise in healthcare billing and coding by conducting timely risk-based audits to assist management in accomplishing workplan objectives.
• Assists in planning audits by identifying potential risk areas, reviewing applicable billing and coding guidelines, and examining departmental/divisional policies, procedures, and agreements.
• Reviews medical records and related documentation to assess the accuracy and completeness of billing and coding, identifying erroneous billing or discrepancies between billing and documentation.
• Assesses coding practices against industry standards, governmental regulations, and payer guidelines to ensure compliance.
• Communicates with the Director, CBM, and Lead Auditor throughout the audit to provide updates on progress, findings, and recommendations.
• Prepares draft reports of findings, including corrective action recommendations, for review by the Lead Auditor, CBM, or Director, with final approval by the Deputy Chief Compliance Officer or Chief University Compliance Officer before issuing to department/division administrators.
• Issues final reports upon completion of the exit meeting and receipt of management's response.
• Assists in developing and delivering training programs for Rutgers healthcare professionals on billing and coding regulations, ensuring compliance with policies and retraining providers when necessary, with timely post-education audits.
• Performs other tasks, including developing training materials for the University community in collaboration with UEC Compliance Officers, General Counsel, Labor Relations, and Employment Equity on topics such as federal and state law, University policies, and collective negotiations agreements.
• Assists in ensuring timely submission of written management responses for final report issuance and evaluating the adequacy of corrective actions.
• Works with the Lead Auditor to develop options for addressing corrective actions and monitoring their progress to ensure risks are mitigated.
• Provides expertise to the UEC Investigation unit by conducting billing and coding analyses to assess the validity of allegations and supplying necessary documentation and findings to the assigned investigator. If serving as Lead Investigator, preparing the Investigation Report for review and approval.
• Keeps leadership informed of status, findings, and observations.
• Maintains coding certifications and staying current with changes in coding standards, regulations, and Rutgers' policies through industry associations offering courses, webinars, and articles.
• Performs other duties as assigned.

Minimum Education and Experience:

• Bachelor's Degree, preferably in business administration, healthcare administration, health information management or other related field or an equivalent combination of education and/or experience.
• Two (2) years of experience in a healthcare billing and coding role/healthcare auditor.

City: Newark

State: NJ

Equipment Utilized:

• MDaudit EnterpriseVarious.
• EHR systems including Epic, Insight, Vista, Axium, Medaptus.

Special Conditions:

• Clean Driving Record.

Posting Number: 25ST0591

About Rutgers University

Rutgers, The State University of New Jersey, is a leading national public research university and the state's preeminent, comprehensive public institution of higher education. Rutgers is dedicated to teaching that meets the highest standards of excellence; to conducting research that breaks new ground; and to turning knowledge into solutions for local, national, and global communities. As it was at our founding in 1766, the heart of our mission is preparing students to become productive members of society and good citizens of the world. Rutgers teaches across the full educational spectrum: preschool to precollege; undergraduate to graduate and postdoctoral; and continuing education for professional and personal advancement. Rutgers is New Jersey's land-grant institution and one of the nation's foremost research universities, and as such, we educate, make discoveries, serve as an engine of economic growth, and generate ideas for improving people's lives.

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