Senior Coding and Reimbursement Auditor

Senior Coding Auditor

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Senior Coding Auditor is responsible for auditing technical and professional services. The individual will communicate performance results to coders, coding leaders, revenue cycle leaders, clinic managers, other executives and/or physicians to collaborate on education and/or improvement plans. Emergent reviews may be performed based on compliance and clinical need. This individual will be required to understand and communicate appropriate reimbursement methodologies for services audited and communicate with compliance as needed. This individual will follow all applicable federal, state, and local guidelines and regulations, including maintaining knowledge of current code sets and regulations, CMS requirements, and applicable third-party payer guidelines as appropriate to coding.

What You Will Do

• Audits hospital/clinic coded charts on a predefined basis pre-bill and/or post bill encounters.
• Develops reports and/or education based on quality audit findings or requested risk areas and evaluates clinicians' and coder coding performance.
• Audit activity may identify risks for escalation of specified service line audits.
• Meets with coders, physicians and/or clinicians whose audits have revealed a pattern of performance gaps.
• Provides education to clinic/hospital coders based on findings from quality coding audits. Collaborates with departments and physician specialties as needed for clinical support on education topics
• May assist the compliance department with specific audit activities, including support for outside agencies such as Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), and other payers, on an as-needed or immediate basis.
• Provides consultant services to Avera affiliated partners as requested by coding leadership.
• Reviews coding disparities between health plans and the provider community to provide recommendations in coordination with managed care and coding leadership teams.
• Serves as an expert coding liaison who collaborates with AMG clinic managers, revenue integrity, revenue cycle, billing teams, charge master committee, pro-fee audit team, health information management, managed care services, and others as necessary.
• Helps improve physician's understanding of coding guidelines when necessary.

Essential Qualifications

• The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
• Required Education, License/Certification, or Work Experience:
• Associate's or Bachelor's degree in health administration from an American Health Information Management Association (AHIMA) accredited school preferred or an equivalent health care field accepted and/or equivalent combination education and experience.
• AHIMA Membership - American Health Information Management Association (AHIMA) Upon Hire or
• Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) Upon Hire or
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) Upon Hire or
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire
• 4-6 years in multi-specialty coding, coding auditing, or related quality assurance work with ICD-10 and CTP code sets.
• Expectations and Standards:
• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera's values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

• PTO available day 1 for eligible hires.
• Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship