Coding & Reimbursement Auditor

Avera; Sioux Falls (SD); On-site; USD 41,000 - 63,000; Full time

Benefits offered by this job

PTO from day 1

Retirement matching up to 5%

Career development and mentorship

Job summary

Avera is seeking an Auditor to support health information management departments with ICD-10, CPT, and HCPCS coding review, DRG and APC reimbursement, and coordination of information between medical records and billing. The role includes developing educational workshops for Avera and non-Avera facilities, and ensuring regulatory alignment at state and federal levels.

The successful candidate will audit charts, provide consultant services on coding issues, deliver trainings, and liaise across

Qualifications

• Associate's in Health Information Management or related field.
• RHIA/RHIT/CCS/CCS-P/CIC/COC/CPC/CRC AHIMA/AAPC certifications upon hire.
• 4-6 years experience in multi-specialty coding, coding auditing, or related quality assurance work with ICD-10 and CPT code sets.

Responsibilities

• Audits hospital/clinic coded charts and provides written reports with findings and recommendations.
• Analyzes financial impact following audit activities based on PPS, CAH and Professional Physician services.
• Provides consultant services to non-Avera Health facilities on ICD-10, CPT, and HCPCS coding and reimbursement issues.
• Provides and coordinates education to coders, physicians and hospital staff on coding and billing findings with detailed reports for tracking.
• Presents in-service education to coders, coding teams, physicians, other clinicians, Avera committees, leadership and others when necessary.
• Assists in communication between health information management and billing departments and between hospitals, clinics and ambulatory care facilities.

Skills

Auditing

Healthcare coding

Data analysis

Communication

Education

Associate's in Health Information Management

RHIA - AHIMA

RHIT - AHIMA

CCS - AHIMA

CCS-P - AHIMA

CIC - AAPC

COC - AAPC

CPC - AAPC

CRC - AAPC

Bachelor's in Health Information Management (preferred)

Job description

Sioux Falls, SD

Full time

Location:

Avera Downtown Building-Sioux Falls

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

$30.75 - $46.00

Position Highlights

You Belong at Avera

A Brief Overview

Assists HIM/Coding leadership in providing consultant services to health information management departments and billing offices with ICD-10, CPT, and HCPCS coding review, DRG and APC reimbursement, and coordination of information between medical record and billing departments. A successful Auditor assists in the organization and presentation of educational workshops and seminars for Avera, including non-Avera facilities A successful Auditor also assists leadership with monitoring and dissemination of information related to state and federal regulations as they apply to a health information management (coding) in acute, long term, and ambulatory care facilities.

What you will do

• Audits hospital/clinic coded charts and provides written reports with findings and recommendations.
• Analyzes financial impact following audit activities based on various types of reviews including but not limited to PPS, CAH and Professional Physician services.
• Provides consultant services to non-Avera Health facilities on ICD-10, CPT, and HCPCS coding, and reimbursement issues as requested.
• Provides and coordinates education to coders, physicians and hospital department staff on coding and billing findings related to chart audits/reviews with detailed reports to track new and repeat findings.
• Presents in-service education to coders, coding teams, physicians, other clinicians, Avera committees, leadership and others when necessary.
• Assists in communication between health information management and billing departments, and between hospitals, clinics and ambulatory care facilities.
• Assists in communication between coding and billing departments for the Avera health system including partner sites as requested.
• Serves as the liaison between hospitals, clinics and Avera Health committees for the collection of baseline data of patient health information (i.e., grant requests, documentation improvement studies and quality data).
• Keeps apprised of Federal contractor requirements for the various regions of Avera which include the following Medicare Contractors for Avera facilities: Noridian Healthcare Solutions, National Government Services (NGS), Novitas Solutions, Wisconsin Physician Service (WPS), and CGS Administrators at the present time.
• Assists Avera facilities through compliance focused Medicare reviews to resolve and minimize risks for a larger audit if compliance not resolved initially. Provide timely Education as needed to departments for all staff involved.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Associate's in Health Information Management or related field.
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Upon Hire or
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) Upon Hire or
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Upon Hire or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) Upon Hire or
• Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) Upon Hire or
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) Upon Hire or
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire or
• Certified Risk Adjustment Coder (CRC) - American Academy of Professional Coders (AAPC) Upon Hire
• 4-6 years experience in multi-specialty coding, coding auditing, or related quality assurance work with ICD-10 and CPT code sets.

Preferred Education, License/Certification, or Work Experience:

• Bachelor's in Health Information Management or related field.

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands‑on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].

At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices:

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.