Coding Auditor
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Job Location:
Appleton, WI - USA
Monthly Salary:
Not Disclosed
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Job Summary
Why ThedaCare
Living A Life Inspired!
Our new vision at ThedaCare is bold ambitious and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care lower costs and a healthier future for our patients our families our communities and our world.
At ThedaCare our team members are empowered to be the catalyst of change through our values of compassion excellence leadership innovation and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development accessible and transparent leadership and a commitment to work/life balance. If youre interested in joining a health care system that is changing the face of care and well-being in our community we encourage you to explore a future with ThedaCare.
Benefits with a whole-person approach to wellness
- Lifestyle Engagement
- e.g. health coaches relaxation rooms health focused apps (Wonder Ripple) mental health support
- Access & Affordability
- e.g. minimal or zero copays team member cost sharing premiums daycare
Summary :
The Coding Auditor performs coding quality audits of records to ensure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education needs for providers and coding team members. Monitors for compliance with regulatory requirements and works closely with corporate compliance. Provides feedback and education to coders when discrepancies and areas of opportunity are identified through auditing and payer denial reviewJob Description:
KEY ACCOUNTABILITIES:
- Performs compliance monitoring and auditing of billing coding and documentation related to inpatient outpatient surgery observation emergency department urgent care and professional services for all payers to ensure compliance with regulatory requirements.
- Reviews and prepares compliance audit reports to ensure ThedaCare meets coding accuracy standards that are set in place.
- Assists in the preparation and response to external oversight agency and commercial payer audits and inquiries including CMS Medicaid RAC HRSA and PERM to ensure appropriate reimbursement. Reviews internal processes to ensure compliance with regulatory requirements.
- Responds to identified areas of risk through investigation and internal audit to ensure compliance with regulatory requirements.
- Assists in the preparation and execution of the annual audit plan as part of the corporate compliance plan.
- Assists in monitoring and responding to corporate compliance hotline reports related to hospital coding.
- Stays current with changing regulatory requirements through review of periodicals compliance association newsletters and review of state and federal regulatory agency work plans to ensure compliance.
- Assists in the development and management of learning management systems and compliance training materials to ensure compliance with regulatory requirements.
- Serves as subject matter expert to educate coders providers and others regarding documentation requirements for accurate coding.
- Interacts with physicians and other patient care providers regarding billing and documentation policies procedures and regulations. Obtains clarification of conflicting ambiguous or non-specific documentation to ensure compliance with regulatory requirements.
- Trains instructs and/or provides technical support to medical providers as appropriate regarding coding compliance documentation regulatory provisions and third party payer requirements to ensure compliance with regulatory requirements.
- Maintains working knowledge of changes and requirements related to compliance/regulations and coding.
QUALIFICATIONS:
- High School diploma or GED preferred
- Minimum three years of experience in hospital coding
- Minimum two years of experience in clinical medical audit review
- Current or obtained within one year of hire Certified Coding Credential obtained through AHIMA or AAPC or RHIT (Registered Health Information Technologist/AHIMA) or RHIA (Registered Health Information Administrator/AHIMA). Minimum certification requirement is one of the following: CCS (Certified Coding Specialist/AHIMA) CPC (Certified Professional Coder/AAPC) CIC (Certified Inpatient Coder/AAPC) or COC (Certified Outpatient Coder/AAPC).
- Current or obtained within one year of hire Certified Clinical Documentation Specialist obtained through Association of Clinical Documentation Integrity Specialists (ACDIS)
PHYSICAL DEMANDS:
- Ability to move freely (standing stooping walking bending pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
- Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties
WORK ENVIRONMENT:
- Normally works in climate controlled office environment
- Frequent sitting with movement throughout office space
- Use of computers throughout the work day
- Frequent use of keyboard with repetitive motion of hands wrists and fingers
Position requires compliance with department specific competencies.
Scheduled Weekly Hours:
20Scheduled FTE:
0.5Location:
ThedaCare Regional Medical Center - Appleton - AppletonWisconsinOvertime Exempt:
NoWorker Shift Details:
DaysRequired Experience:
IC
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
ThedaCare is a comprehensive healthcare system dedicated to individualized care located throughout Northeast Wisconsin.
