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The Toledo Clinic
General Summary:
Responsible for reviewing, analyzing, disseminating, and reporting data on chart audits as well as audit documentation requirements of services billed per pre-established criteria approved by the Director of Compliance. Responsible for the processing of Medicare and other insurance carrier audit requests, such as Performant Audits, Targeted Probe Reviews, Overpayment Recoupment Efforts.
Assist Internal Auditors as needed. Assist Medical Offices for coding and claims as needed.
Works under the Supervision of the Quality and Compliance Director
Principal Duties & Responsibilities:
Example of Essential Duties:
Compliance Program under the direction of the manager(s).
Other Essential Duties May Include (but are not limited to):
Knowledge, Skills & Abilities Required:
Required:
- Minimum 5 years’ experience in Coding, Billing, and Auditing.
- Knowledge of computer software, HTML forms design, data base spreadsheets, and word processing.
- Knowledge of medical records documentation policies and procedures.
- Knowledge of Medical coding documentation requirements.
- Knowledge of medical terminology.
- Requires travel during business hours, valid state driver’s license preferred.
- Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame.
- Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed.
- Demonstrates adaptability to expanded roles.
Education: Diploma, certificate, or degree in medical coding and auditing.
Preferred:
- CPC Certification