Franciscan Missionaries of Our Lady Health System
Franciscan Missionaries of Our Lady Health System
Franciscan Missionaries of Our Lady Health System is a large nonprofit Catholic healthcare organization serving communities across Louisiana and the greater metropolitan area of Mississippi. Its care network includes hospitals, clinics, and physicians providing a broad range of health services, with work centered on patient care, community health, and education. Headquartered in Baton Rouge, Louisiana, the organization brings together a sizable healthcare workforce focused on caring for patients and strengthening health outcomes across the region.

Reimbursement Auditor, Louisiana (Remote)

Conduct remote audits of hospital coding, claims, medical records, and charges. Support regulatory compliance, accurate reimbursement, billing resolution, and revenue-cycle improvement.

Description

  • Audit Charge Master-driven and HIM-assigned codes and medical-record documentation against itemized charges and facility-assigned codes for government and non-government accounts.
  • Correct inaccurate items and services.
  • Help resolve billing edits and provide coverage guidance for billable services.
  • Monitor the Federal Register, Medicare and Fiscal Intermediary transmittals, bulletins, memorandums, NCD, LCD/LMRP, OCE, and CCI edit-management resources.
  • Inform designated hospital team members about current and forthcoming APC and other government-program regulations.
  • Deliver twice-yearly training for designated hospital staff and provide education to revenue-producing and ancillary departments as needed.
  • Review CMS, Medicare, and Medicaid bulletins and implement internal updates that support coding and charge-practice compliance.
  • Record monthly findings and recommend actions to prevent recurring billing issues and advance process-improvement initiatives.
  • Help reduce bill rejections and payment delays arising from coding and billing practices.
  • Prepare reports covering process-improvement recommendations and systemic claim-processing issues.
  • Audit medical records to verify that services are accurately represented on itemized statements and related documentation.
  • Evaluate selected retrospective claims and records for accuracy and defend facility charging and coding practices during focused audits.
  • Identify APC-related coding and billing issues and verify outpatient claims use the correct CPT-4 and HCPCS Level II codes.
  • Analyze how changes to the Charge Description Master and billing practices affect revenue.
  • Complete other assigned duties.

Requirements

  • At least three years of experience.
  • Associate degree in Nursing or Health Information Management.
  • Proficiency with payment review systems, payment methodologies, and insurance terminology.
  • Ability to synthesize and evaluate data.
  • In-depth knowledge of ICD-9-CM, HCPCS, and CPT-4 nomenclature, codes, and guidelines.
  • Proficiency with 3M coding software.
  • Current RHIT or LPN license.

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