Coding Auditor

ThedaCare; Appleton (WI); On-site; USD 18,000 - 26,000; Full time

Benefits offered by this job

Health benefits

Wellness programs

Job summary

The Coding Auditor at ThedaCare performs coding quality audits of records to ensure appropriate code assignments in accordance with CMS guidelines. Provides ongoing feedback and education to coders and providers, and supports corporate compliance efforts.

Located at ThedaCare Regional Medical Center in Appleton, this role emphasizes regulatory compliance, audit planning, and collaboration with physicians to clarify documentation for accurate coding.

Qualifications

• Experience in hospital coding and clinical medical audit review is required.
• Certified Coding Credential (CCS/CPC/CIC/COC) preferred.
• ACDIS CDS certification within one year of hire is expected.

Responsibilities

• Perform compliance monitoring and auditing of billing, coding, and documentation.
• Review audit reports to ensure coding accuracy standards.
• Assist in external audits and inquiries (CMS, Medicaid, RAC, HRSA, PERM).
• Maintain knowledge of regulatory changes and participate in annual audit planning.

Skills

Regulatory compliance

Auditing

Coding accuracy

Education

High School diploma or GED

AHIMA/CPC/CCS or RHIT/RHIA certification

ACDIS CDS certification (within 1 year)

Tools

CMS guidelines

Job description

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 you’re 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

• 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

Job Summary

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 review

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.

Additional Details

Scheduled Weekly Hours: 16

Scheduled FTE: 0.4

Location: ThedaCare Regional Medical Center - Appleton - Appleton,Wisconsin

Overtime Exempt: No

Worker Shift Details: Days About ThedaCare

About ThedaCare

ThedaCare is a community health system consisting of seven hospitals, numerous clinics and related services. We are the third largest health care employer in Wisconsin and the largest employer in the state's second largest economic market - Northeast Wisconsin - with approximately 6,800 employees. Through our 100-year history, ThedaCare has woven itself into the very fabric of the communities we serve. For our employees, ThedaCare offers an environment that not only welcomes but also encourages innovative thinking and fresh approaches to today’s health care challenges. We’ve improved the health of thousands of individuals. We know this because we track our quality and constantly seek to improve our care and services for the members of our communities. This job posting is available in other languages besides English free of charge. ThedaCare is an Equal Opportunity Employer. ThedaCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ancestry, color, religion, sex, gender identity, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.