Radiation Oncology/Medical Oncology Compliance Auditor

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Position Description:

Under minimal supervision, the Radiation Oncology Auditor - to conduct internal coding and billing audits and review applying applicable billing, coding, and related reimbursement guidelines, to include federal/state laws and regulatory requirements affecting daily business operations applicable to Radiation and Radiology services. Upon request, support network practices with audit services of medical record documentation, including but not limited to the following services: evaluation and management, radiation and radiology professional and technical services, and evaluation and management services. Occasionally conduct reviews and/or audits of Medical Oncology services: evaluation and management, laboratory and infusion services and other services common to the Medical Oncology specialty. Collaborate with other McKesson Specialty Health departments and US Oncology Network practices to provide coding and billing guidance and support. Coordinate and participate in other projects and duties as needed or requested. Must have exceptional communication skills and be able to speak to and relate to Providers, APPs, and Other Healthcare Professionals. This position requires a close working relationship with clinical, coding, and billing staff. Extensive knowledge of government regulations, applicable reimbursement laws and regulations required. Support and adhere to the US Oncology Compliance program, to include the Code of Ethics and Business Standards.

Key Responsibilities:

• Conduct coding and billing reviews and audits in accordance with Compliance department standard operating procedures.
• Comprehend and adhere to department procedures related to billing and coding audits and reviews.
• Complete audits/reviews within designated timelines to minimize impact on results.
• Analyze results of billing and coding audits to identify patterns, trends, and variations in coding, documentation practices, operational workflows, and billing practices, ensuring adherence to federal payor guidelines.
• Prepare reports of findings and recommendations for improvement for internal review and distribution to business leaders and Compliance leadership.
• Collaborate with the education group to ensure that audit findings are accurate and accessible for training purposes.
• Maintain up-to-date knowledge of E&M, CPT, and ICD-10-CM coding and coding guidelines.
• Identify, apply, and validate current federal payor guidelines and industry-standard clinical indicators, risk factors, and treatment protocols for clinical validation of payment-impacting code assignments.
• Perform reviews and audits using medical records to assess the documentation against base code sets impacting payment, ensuring compliance with Medicare, Medicaid, and other federal payor guidelines.
• Validate E&M, CPT, and ICD-10-CM codes assigned for Medicare, Medicaid, and other government payors based on provider selection.
• Document results and necessary corrections clearly, providing supporting evidence from medical records and authoritative guidance.
• Maintain professional standards when providing feedback to managers and other leadership members.
• Possess experience and knowledge of Radiation Oncology, Diagnostic Radiology, and Medical Oncology coding and documentation.

Additional Skills:

• Work independently and proactively with urgency and tact.
• Exhibit extreme detail orientation with the ability to track requirements to work plans.
• Proficiency in Microsoft Word, Excel, and PowerPoint.

Minimum Job Qualifications:

• 6+ years of relevant experience.
• 3+ years of direct experience in CPT, ICD-10-CM, and HCPCS coding for Radiation Oncology and like services.

Education/Training:

• Current CPC or ROCC certification required, CPMA and/or CCS-P certification a plus.
• Bachelor's degree in Healthcare Administration or Health Information Management preferred.

Critical Skills:

• At least 4 years of auditing experience and 2 years of coding experience.
• Active ROCC and/or CPC certification.
• Must be familiar with compliance and government regulations and applicable reimbursement laws and regulations relating to Radiation Oncology and like services and reimbursement in a physician outpatient environment.
• Demonstrated knowledge of Medical Terminology, Anatomy & Physiology, and expertise in federal payor guidelines, third-party payer reimbursement, coding, and documentation requirements.
• Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).
• Laboratory Billing and regulatory guidance is a plus.

Other Requirements:

• General office demands.
• Flexible working hours may be required.
• Completion of a coding assessment may be requested.

Travel:

Must be available for up to 10% travel.

Must be authorized to work in the US. Sponsorship is not available for this position.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, pleaseclick here.

Our Base Pay Range for this position

McKesson is an Equal Opportunity Employer

McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

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