Coding Auditor

WellSpan Health; Ephrata (Lancaster County); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement savings plan

Paid time off (PTO)

Education assistance

DailyPay

Expanded Paid Parental Leave

Job summary

WellSpan Health is seeking a Coding Compliance Auditor to perform clinical documentation audits, evaluations, and reviews to ensure regulatory compliance. The role includes preparing reports, identifying issues, and recommending corrective actions, as well as developing and delivering training on coding compliance for staff.

Key duties include proactive/reactive coding reviews, investigation of issues, and support for enterprise-wide documentation, coding, and billing processes.

Qualifications

• Extensive knowledge of ICD-9/ICD-10 and CPT coding principles and guidelines.
• Excellent written/oral communication and computer skills.
• Works effectively in a team environment.

Responsibilities

• Performs proactive or reactive coding compliance reviews to identify or quantify potential issues.
• Investigates and recommends action when compliance issues are found; follows up on corrective actions.
• Assists with coding compliance implementation across the WellSpan system.
• Develops and disseminates training on coding compliance for employees.

Skills

Coding & auditing

Written & spoken communication

Teamwork

Education

Associates Degree

Job description

JOB DESCRIPTION

Performs clinical documentation audits, evaluations and other reviews for the System to ensure and assess compliance with applicable laws and regulations. Prepares and presents written and oral reports summarizing audit work, issues identified and recommendations to correct issues to management. Develops and disseminates education and training programs to employees.

General Summary

Performs clinical documentation audits, evaluations and other reviews for the System to ensure and assess compliance with applicable laws and regulations. Prepares and presents written and oral reports summarizing audit work, issues identified and recommendations to correct issues to management. Develops and disseminates education and training programs to employees.

Responsibilities

Duties and Responsibilities

Essential Functions

• Performs proactive or reactive coding compliance reviews as needed to identify or quantify potential issues.
• Investigates and recommends action to be taken when compliance issues are found. Monitors implementation of recommended corrective action and performs follow up reviews where necessary.
• Assists with coding compliance implementation throughout the WellSpan.
• Assists in the development and dissemination of education and training processes for the employees regarding coding compliance related activities.
• Assists with any investigations in accordance with the investigation protocol established by the organization.
• Assists in responding to questions, issues, concerns and reports of possible coding or billing misconduct reported or identified through the coding hotline, Help Desk calls, or other reporting lines.
• Supports the organization's commitment to comply with all federal, state, and local standards, with an emphasis on prevention of fraud and abuse.
• Promotes and adheres to the Code of Conduct and the elements of the Compliance Program and exercises due diligence to ensure compliance with policies and legal requirements.
• Prepares written reports pertaining to determinations and recommendations resulting from routine audits and/or assigned special projects. Presents report to appropriate managers and boards.
• Provides guidance to Enterprise Applications for documentation, coding and billing, including the creation of system billing edits.

Common Expectations

• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Maintains appropriate records, reports, and files as required.
• Participates in administrative staff meetings and attends other meetings as assigned.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Travel Requirements

• Estimated Amount: - Travel required.

Qualifications

QUALIFICATIONS

Minimum Education

• Associates Degree Required

Work Experience

• 3 years Coding/Auditing experience. Required

Licenses

• Certified Professional Coder Upon Hire Preferred or
• Certified Coding Specialist Upon Hire Preferred or
• Certified Coding Specialist - Physician BasedUpon Hire Preferred

Knowledge, Skills, And Abilities

• Extensive knowledge of ICD-9/ICD-10 and CPT coding principles and guidelines.
• Excellent written/oral communication and computer skills.
• Works effectively in a team environment.

Benefits Offered

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)