CLEARANCE: **This position requires the ability to obtain a Public Trust Clearance** REQUISITION NUMBER: 022818.02-C10p FUNCTIONAL / LABOR CATEGORY: Medical Billing Auditor POSITION TITLE: Consultant/Senior Consultant LOCATION: This position is a telework position available Nationwide
DESCRIPTION: Sehlke Consulting is now hiring a team of Medical Billing Auditors to perform compliance assessment supporting the Department of Veteran’s Affairs. The main objective is to ensure the accuracy of medical billing. The goal is to protect against fraudulent claims and billing activity, to remedy over-coding, bad unbundling habits, code overuse, and to bill appropriately for documented procedures.
EDUCATION: • Bachelor's degree in Accounting or related field
CERTIFICATION(s): Certified Fraud Examiners (CFE) designation is preferred.
LABOR CATEGORY / DUTIES: • Ensure appropriate methodology to include financial controls, identification of trends and unusual patterns, reimbursement deficiencies, and to improve processes. • Ensure that appropriate services are provided in accordance with examination protocol and medical billing practices. • Ensure vendor billing processes maintain appropriate financial internal controls to review and adjust charges prior to invoicing the VA. • Identify unusual examiner patterns based on trends identifiable to the vendor/provider identification number. • Identify deficiencies in the reimbursement process and opportunities for appropriate reimbursement. • Provide a detailed report listing the findings and any adjustments required to the invoices for all inappropriately invoiced services. • Make recommendations for improvements in processes or policies.
EXPERIENCE REQUIRED: • A completed college or technical degree program related to the position (e.g., accounting, finance, fraud examiner, etc.). • Experience with Medicare and Medicaid billing, including CPT coding experience. • At least five (5) years in conducting billing audits/assessments preferably specific to medical billing. • Knowledge of audit processes involving medical terminology.
Founded in 2011, Sehlke Consulting is a rapidly-growing Service-Disabled Veteran-Owned Small Business (SDVOSB) and Historically Underutilized Business Zone (HUBZone) headquartered in Arlington, VA – an Equal Opportunity Employer that values the strength diversity brings into the workplace. Individuals with Disabilities and Protected Veterans are encouraged to apply.