HIM Coding Auditor

Universal Health Services, Inc.; Wayne (PA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401(K) with company match

Tuition Reimbursement

Job summary

Universal Health Services, Inc. seeks a Coding Auditor to determine ICD-10, CPT-4, and HCPCS coding alignment with clinical documentation and to validate medical necessity per LCDs.

The role requires CPC certification and experience in professional billing, auditing, and the revenue cycle. The position involves reviewing documentation, educating providers on coding requirements, and ensuring timely, accurate audits across IPM services.

Qualifications

• Auditing experience required.
• AAPC CPC Certification required.
• Knowledge of CPT-4/ICD-10, CMS guidelines, and third party billing policies is essential.
• Understanding of the revenue cycle and related processes preferred.
• Strong organizational, detail-oriented, and problem-solving skills.

Responsibilities

• Performs accurate review of clinical documentation to ensure ICD-10, CPT-4 and HCPCS coding alignment with medical records.
• Reviews audit samples and reports findings to Coding Manager, meeting productivity and quality targets.
• Educates providers on documentation requirements to support coding and maximize reimbursements.
• Contributes to audits and education plans; recommends process improvements.
• Maintains knowledge of CPT-4/ICD-10, billing guidelines, and coding policies; pursues continued education and CPC certification.

Skills

Auditing experience

Billing knowledge

CPC Certification

Education

High School Diploma or GED

Associates Degree preferred

Tools

Cerner

Epic

IDX

Job description

Responsibilities

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve.

To learn more about IPM visit Physician Services - Independence Physician Management - UHS.

POSITION OVERVIEW

Coder Certification Required. The Coding Auditor is responsible for determining that ICD-10, CPT-4, and HCPCS coding is supported by the clinical documentation in the medical record as well as validating medical necessity per CMS Local Coverage Determination (LCD). Applies working knowledge of medical terminology, anatomy, CPT-4 and ICD-10 codes and coding skills/ experience to ensure timely and accurate audits of clinical documentation as requested.

Key Responsibilities

• Performs accurate and timely review of clinical documentation as requested to ensure that ICD-10, CPT-4 and HCPCs coding is supported by the clinical documentation in the medical record. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
• Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report accurate and timely findings to the Coding Manager. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
• Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured.
• Provides feedback on audit and education plans and materials and makes recommendations for updates that will enhance the auditing process.
• Maintains an expanded knowledge base CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies. Meets continued education guidelines to maintain current AAPC CPC certification.
• Exercises good judgement in escalating identified coding trends that may negatively impact productivity, quality or revenue to enhance clinical documentation to support codes billed, drive consistency across IPM, mitigate claim denials, expedite reprocessing of claims and maximize opportunities to enhance front end, coding-related claim edits to facilitate first pass resolution.
• Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.

Qualifications

High School Graduate/GED required. Associates Degree preferred. 3 – 5 years of experience required working in a healthcare (professional) billing, health insurance, coding, auditing or equivalent operations work environment.

• Auditing experience required.
• AAPC CPC Certification required.
• Healthcare (professional) billing, CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies.
• Understanding of the revenue cycle and how the various components work together preferred.
• Excellent organization skills, attention to detail, research and problem solving ability.
• Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.
• Service-oriented/customer‑centric.
• Strong computer literacy skills including proficiency in Microsoft Office.
• Billing software (e.g., Cerner, Epic, IDX) experience are highly desirable.

Benefits

• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Competitive Compensation & Generous Paid Time Off
• 401(K) with company match
• Tuition Reimbursement and much more!

Independence Shared Services is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Shared Services. No fee will be paid in the event the candidate is hired as a result of the referral or through other means.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 94,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhsinc.com

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates with matching skillset and experience with the best possible career at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail etc. If you feel suspicious of a job posting or job‑related email, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.