Ambulatory Services Auditor/CDS 1

St. Charles Health System; Salem (OR); Remote; USD 62,000 - 93,000; Full time

Benefits offered by this job

Medical, Dental, Vision for you and 1

403b with up to 6% match

Earned Time Off

Growth Opportunities within Healthcare

Job summary

St. Charles Health System is seeking an Ambulatory Services Auditor and Clinical Documentation Specialist I in Revenue Integrity.

This role audits outpatient, inpatient, and ambulatory documentation for coding accuracy, provides guidance to physicians and staff, and helps maintain compliance with ICD-10-CM and CPT-4/HCPCS guidelines. A focus on education and system-wide improvements supports patient care and revenue integrity.

Qualifications

• Required: High school diploma or GED.
• Preferred: Associates degree in Health Information Technology or related field.
• Required licensure/certification includes RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN, or LPN.
• Preferred: CPMA, CRC, RN, LPN.

Responsibilities

• Conduct system‑wide pre‑visit or post‑visit chart reviews of professional services for hospital and clinic settings.
• Audit and monitor all lines of system business for coding across outpatient, inpatient and ambulatory services.
• Provide feedback and education to HIM Coding teams to ensure compliance with quality coding standards.
• Evaluate medical records to support acuity, risk, and codes per ICD‑10‑CM and CPT‑4/HCPCS rules.
• Develop and update procedure manuals to maintain coding standards.
• Assist in coding education and training across the system.
• Guide physicians and staff to resolve incomplete/missing records and nonconforming codes.
• Recommend process changes to reduce losses and improve efficiency.
• Monitor trends and prepare reports on documentation, coding issues, and denials.

Education

High school diploma or GED

Associates degree in Health Information Technology or related field

RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN, or LPN

CPMA, CRC, RN, LPN preferred

Job description

Pay range: $62,316 - $93,454 annually, based on experience.

In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position.

Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin.

About St. Charles Health System

St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture.

What We Offer

• Competitive Salary
• Comprehensive benefits including Medical, Dental, Vision for you and your immediate family
• 403b with up to 6% match on Retirement Contributions
• Generous Earned Time Off
• Growth Opportunities within Healthcare

ST. CHARLES HEALTH SYSTEMJOB DESCRIPTION

TITLE

Ambulatory Services Auditor and CDS I

REPORTS TO POSITION

System Revenue Integrity Director

DEPARTMENT

Revenue Integrity

DATE LAST REVIEWED

May 2023

OUR VISION

Creating America’s healthiest community, together

OUR MISSION

In the spirit of love and compassion, better health, better care, better value

OUR VALUES

Accountability, Caring and Teamwork

DEPARTMENTAL SUMMARY

The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver a delightful, transparent, and seamless experience to our patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner.

POSITION OVERVIEW

The Ambulatory Services Auditor and Clinical Documentation Specialist I is responsible for conducting audits of outpatient, inpatient and ambulatory service medical documentation across St. Charles Health System to ensure compliance with ICD-10-CM and CPT-4 coding regulations, rules, and guidelines. This position will also provide education, feedback, and guidance to multiple parties, as needed. This position does not directly manage any other Caregivers.

ESSENTIAL FUNCTIONS AND DUTIES

• Conduct system-wide pre- visit or post-visit chart reviews of professional services to include both hospital and clinic/office settings of care.
• Audit and monitor all lines of system business for coding, to include outpatient, inpatient and ambulatory services.
• Perform audits on/for the HIM Professional Services Coding team and provide feedback and education as needed to ensure compliance with quality coding standards.
• Evaluate medical records to ensure the accuracy of clinical documentation to support the acuity of the patient, risk profiles for HCC capture and recapture, and diagnostic and procedural code integrity in compliance with ICD-10-CM and CPT-4/HCPCs rules and guidelines.
• Develop and update procedure manuals to maintain standards for correct coding.
• Assist in conducting system-wide education and training in coding of professional services.
• Assist in setting the direction for coding compliance and education.
• Assist in providing technical guidance to physicians and other departmental staff in identifying and resolving issues such as incomplete or missing records, or codes that do not conform to approved coding guidelines.
• Recommend process changes and improvements within departmental and operational policies and procedures or system changes to reduce losses or improve efficiency.
• Monitor trends and prepare reports on such topics as documentation or coding issues and denied claims, for review by senior auditors and or management.
• Supports the vision, mission, and values of the organization in all respects.
• Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Provides and maintains a safe environment for caregivers, patients, and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.
• May perform additional duties of similar complexity within the organization, as required or assigned.

EDUCATION

Required: High school diploma or GEDPreferred: Associates degree in Health Information Technology or related field

LICENSURE/CERTIFICATION/REGISTRATION

Required: RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN, or LPNPreferred: CPMA CRC, RN, LPN

EXPERIENCE

Required: 0-3 years of coding experience required, or an equivalent combination of education and experience. Knowledge of current Medicare regulations, including, MPFS, IPPS and OPPS.Preferred: Inpatient, Outpatient, and Ambulatory services coding preferred. Physician Evaluation and Management coding experience preferred.

PERSONAL PROTECTIVE EQUIPMENT

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

ADDITIONAL POSITION INFORMATION

PHYSICAL REQUIREMENTS: Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level. Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation. Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing. Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle. Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level. Exposure to Elemental Factors Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category No Risk for Exposure to BBP. Schedule Weekly Hours:40 Caregiver Type:Regular Shift:First Shift (United States of America) Is Exempt Position?Yes Job Family:AUDITOR Scheduled Days of the Week:Monday-Friday Shift Start & End Time:07:00-15:00