Coding Compliance Auditor & Educator

1000 Wellstar Health System, Inc.; Georgia; Hybrid; USD 85,000 - 115,000; Full time

Job summary

Wellstar Health System, Inc. invites experienced coding professionals to join our team as a Coding Compliance Auditor. Under the Coding Compliance Manager, you will audit professional fee coding and ensure accuracy per CPT, ICD-10-CM, HCPCS, and Medicare/Medicaid guidelines.

You will prepare audit findings, train physicians on documentation and coding practices, and help improve compliance. Requirements include 5+ years auditing or coding compliance in healthcare, degrees, and relevant

Qualifications

• High degree of coding accuracy.
• Attention to detail in coding and documentation.
• Excellent written and verbal communication skills.
• Public speaking, presentations and educational activities.
• Time management and ability to work independently.
• Learning agility and problem solving.
• Confidentiality and professional demeanor.

Responsibilities

• Audit medical record documentation to support codes in accordance with professional standards and regulations.
• Communicate audit findings to physicians and staff with references to authoritative guidance.
• Perform research related to compliance and coding issues.
• Schedule and conduct meetings with providers to review findings.
• Assist in creating/updating coding references and training materials.
• Pursue ongoing education to maintain compliance with laws and regulations.
• Maintain records of time spent on assignments.

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift Day (United States of America)

Job Summary

Under the direction of the Coding Compliance Manager, conducts independent audits of professional fee coding. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines. Prepares written reports of findings and leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Also responsible for providing assistance with coding inquiries from providers, coding, staff, etc. This position requires knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties. Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.

Core Responsibilities and Essential Functions

• Performs Audits
  • Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians in accordance with professional standards, organizational policies and procedures, laws, and regulations.
  • Creates and communicates clear and accurate audit findings to physicians and charge review staff which include references for authoritative guidance.
  • Performs research related to compliance and coding issues.
  • Schedules meetings with providers.
• Ensure compliance with coding guidelines
  • Assist in creating and updating coding reference materials and presentations as needed.
  • Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.
• Other Activities (5)
  • Communicate with Management regarding trends, issues or assistance needed.
  • Maintains an accurate record of time spent on all assignments.

Required Minimum Education

• Associate's Degree from an accredited college required or in lieu of associates degree candidate must meet the minimum experience
• Bachelor's Degree from an accredited college in a healthcare related field.

Preferred Required Minimum License(s) and Certification(s)

• Cert Prof Coder 1.00 Required
• Cert Coding Spec 1.00 Required
• Certified Professional Medical Auditor CPMA Upon Hire Preferred

Required Minimum Experience

• Minimum 5 years auditing or coding compliance experience in a physician practice
• Minimum 7 years coding or billing (Revenue Cycle) experience in a physician or outpatient coding environment.

Required Minimum Skills

High degree of coding accuracy. Attention to detail Ability to communicate effectively both verbally and in writing complicated coding and compliance concepts and maintain effective working relationships with physicians and staff. Proficient in public speaking, presentations and educational activities. Objective and detailed approach to problem solving. Extensive knowledge of Medicare regulations, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement required. Must maintain a professional appearance and demeanor while working with physicians. High degree of coding accuracy. Attention to detail. Must be able to learn quickly and work independently to address a variety of complex issues. Excellent time management skills required Must be flexible and adapt well to change Ability to work independently, prioritize work and meet deadlines. Strong Knowledge of Microsoft Word, Excel, PowerPoint and Outlook is required. Ability to maintain confidentiality of sensitive information.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

Mission, Vision & Values

At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery. OUR MISSION: To enhance the health and well-being of every person we serve. OUR VISION: Deliver world-class healthcare to every person, every time. OUR VALUES: We serve with compassion We pursue excellence We honor every voice Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality. Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top‑note care for our patients, but also foster the culture of Wellstar as a Great Place to Work.