Mosaic Medical prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income.
We focus on a holistic approach to patient care by incorporating behavioral health, pharmacy, and nutrition support to serve patients in the most meaningful way. At Mosaic Medical, you will work with incredibly dedicated and mission-centered peers and be part of a dynamic team based environment.
Mosaic Medical offers more than just a job, it is a lifestyle. A lifestyle of serving others. A lifestyle of being an integral part of your community. A lifestyle that offers work/life balance. A lifestyle of enjoying the outdoors! Central Oregon offers over 300 days of sunshine a year, so enjoy a PTO day on the mountain, biking/hiking trails, or the river! A lifestyle that improves lives, including yours. Of course, we also offer a great benefit package!
The Audit and Compliance Specialists contributes to Mosaic Medical’s Revenue Cycle by performing specific billing functions utilizing EPIC billing software and workflows. This position will be responsible for the entry of specific charges into the system, will be assigned to specified work queues, and will work with the team to identify potential areas to review for charges submission errors. This position will be responsible for the periodic review of the documentation in charts and assist with the on-going training of the professional staff making documentation entries.
• Responsible for the resolution of claims in the Charge Review WQ and Claim Edit WQ, identify trends and opportunities for additional training as it pertains to documentation.
• Conducts audits of professional claims billed out on both CMS-1500 and UB04 bill formats, to ensure appropriate charges are captured and to identify additional areas for training.
• Works with supervisor to identify potential claim outliers on large payer plans and makes recommendations for audits.
• Coordinates with the Billing Software vendor to identify outdated or incorrect codes for procedures and make recommendations for the modification of charging rules as appropriate.
Skills & Knowledge
Knowledge of billing/collections, traditional health insurance plans, Medicare, Medicaid and worker’s compensation. Knowledge of CPT and ICD9, ICD10 coding principles. Knowledge of third-party operating procedures and practices. Ability to understand documentation provided in patient chart related to charge entries and the concept of maximum reimbursement. Ability to use computerized patient management billing software. Understanding of Insurance Explanation of Benefit. Ability to research and take necessary action to collect on unpaid claims and patient accounts. Skillful in the use of calculators, computers, spreadsheet software, word processing software. Prefer someone familiar with HIPAA. Excellent general office skills including use of fax, copier and phone system.