Billing Auditor at Planned Parenthood CWNY

Rochester, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

29 Apr, 26

Salary

62608.0

Posted On

29 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Auditing, Revenue Cycle Management, Claims Scrubbing, Denial Management, Corrective Action Planning, Workflow Improvement, Standard Operating Procedures (SOPs), Payer Relationship Management, Data Analysis, ICD Coding, CPT Coding, HCPCS Coding, Medical Billing, Collections, Analytical Skills, Problem-Solving

Industry

Hospitals and Health Care

Description

Description Billing AuditorBuffalo, Rochester, or Syracuse, NY Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment. No matter what. In support of PPCWNY’s mission and the collaboration with Shared Services, the Billing Auditor evaluates Revenue Cycle outcomes to identify and recommend opportunities for improvement to Revenue Cycle leadership in the planning, implementation, and management of the operations and daily workflows of the Revenue Cycle team. The Billing Auditor works collaboratively with the Revenue Cycle Leadership Team to ensure established workflows and procedures are implemented, to support Billing and Collections integrity and ensure revenue cycle goals are achieved. The Revenue Cycle Billing Auditor also works closely with staff and Planned Parenthood stakeholders to establish and maintain collaborative relationships to accomplish strategic Revenue Cycle objectives across departments and multiple affiliates in Shared Services. Essential Functions 70% Auditing and Corrective Action Evaluates charge capture, claims scrubbing and sliding fee discount practices to ensure efficiency, accuracy, and completeness of encounters, claims and transactions in compliance with payer rules and regulations Maintains and ensures a disciplined and effective approach to discover root causes of denials, underbilling, overbilling, underpayment, and aging A/R Reports to Revenue Cycle Management, Affiliate HS/RC Monthly meetings, and Quality Risk Management Committees on trends, findings, and opportunities for improvement detailing findings and high-risk items that leaders should be monitoring Develops and recommends corrective action plans including work queues which identify and sequence the activities needed to ensure that identified issues are resolved accurately and in a timely manner to meet deadlines Recommends modifications to established practices and procedures or system functionality based on findings to improve workflows, to standardize processes and maximize reimbursement 30% Collaborative Problem Solving and Reporting Supports the documentation and maintenance of Revenue Cycle Standard Operating Procedures (SOPs) Supports the documentation of Revenue Cycle training materials and presentations Works collaboratively with the Revenue Cycle Leadership to ensure effective, consistent, and timely communication across affiliates Builds and manages relationships with Payers to identify and resolve claim billing and processing issues Works collaboratively within Revenue Cycle and with other stakeholders across departments and affiliates utilizing both verbal and written communication to improve Revenue Cycle outcomes Manages individual projects as assigned and provide weekly status reports Performs data processing, analysis and reporting of Revenue Cycle activities and metrics with supporting detail Other Accountability Activities Attends and participates in team meetings, and other required meetings or training opportunities Performs other duties as assigned Handles confidential and non-routine information with sensitivity Practices a customer-oriented and team approach in carrying out job responsibilities Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs Requirements Qualifications Applicants must possess the following qualifications (or equivalent combination of education and experience): Education Bachelor’s degree in Business or Healthcare Administration or related field preferred Certified Professional/Medical Coder or Certified Professional Medical Auditor desired Experience Minimum 3 years of experience in medical billing and collections, including follow-up on unpaid claims, researching insurance claims issues, and appealing to insurance companies for denied claims within standard billing cycle timeframes Minimum 3 years of experience with computerized billing/receivables system and reports Experience with NextGen practice management system preferred In-depth knowledge of Governmental and non-Governmental insurance guidelines and other healthcare funding programs In-depth knowledge of ICD, CPT, and HCPCS coding as well all billing, CCI, MUEs, and other relevant coding/billing guidelines Ability to read and interpret medical procedures and terminology Knowledge, Skills, & Abilities Must have excellent communication skills (verbal and written) Must be sensitive to patient’s financial and clinical needs while maintaining the patient’s confidentiality Must be able to multi-task and work in a fast-paced environment effectively under deadlines Must have exceptional attention to detail and take pride in work Must demonstrate strong analytical and problem-solving skills Must be able to work independently and as a team player Must have strong interpersonal skills that foster a cooperative teamwork environment Computer skills must include advanced level in Excel and other MS Office programs Must be able to work a flexible schedule with ability to travel to multiple sites when needed Must have reliable transportation and/or a valid driver’s license not in jeopardy of being revoked Planned Parenthood seeks candidates who are proficient in two or more languages A commitment to PPCWNY’s mission, vision and values along with a commitment to providing services to a wide range of clients and to the goals of PPCWNY is essential Working Conditions Standard office environment May experience visual fatigue working at computer with potential extended periods of sitting Well-lit/ventilated Physical Requirements Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without accommodation Ability to travel to all agency locations as assigned Work Schedule This is a full-time, 40 hour a week, position; regular schedule will be Monday – Friday with occasional evenings and weekends. Benefits & Compensation At PPCWNY, we are committed to equitable compensation practices and transparency. In alignment with these efforts, the pay for this position ranges from $54,080 to $62,608 per year. Actual compensation will be determined by experience and other factors permitted by law. In addition to competitive compensation, PPCWNY offers an extensive benefits package with generous Paid Time Off, 10 paid holidays, affordable medical, dental, and vision options, Health Savings Account or Flexible Spending Account, 401(k) with match, and much more! Planned Parenthood of Central and Western New York is an equal opportunity employer.

Responsibilities

The Billing Auditor evaluates Revenue Cycle outcomes, focusing 70% of time on auditing charge capture, claims, and discount practices to ensure compliance and identify root causes of billing issues. The remaining 30% involves collaborative problem-solving, supporting SOP documentation, and managing payer relationships to improve overall Revenue Cycle objectives.