Coding & Reimbursement Auditor

Avera Health; Sioux Falls (SD); On-site; USD 42,000 - 63,000; Full time

Benefits offered by this job

PTO on day 1

Up to 5% retirement matching

Career development & mentorship

Inclusive employer

Job summary

Avera Health is seeking an Auditor to support health information management, coding review, and reimbursement processes across hospitals and clinics in Sioux Falls. You will audit charts, review ICD-10 and CPT coding, and present findings to improve accuracy and compliance.

You will partner with HIM, coding teams, physicians, and billing staff to educate on findings, ensure regulatory compliance, and maintain data integrity across multiple sites.

Qualifications

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

Responsibilities

• Audits hospital/clinic coded charts and prepares written reports with findings and recommendations.
• Analyzes financial impact after audits across PPS, CAH and Professional Physician services.
• Provides and coordinates education to coders, physicians, and staff on coding and billing findings.
• Presents in-service education to coders, physicians, and committees as needed.
• Acts as liaison between HIM and billing departments across facilities.
• Keeps apprised of CMS and regional contractor requirements to minimize audit risks.

Skills

Coding auditing

Effective communication

Team collaboration

Attention to detail

Education

Associate's in Health Information Management

RHIA certification

RHIT certification

CCS certification

CCS-P certification

CIC certification

COC certification

CPC certification

CRC certification

Bachelor's in Health Information Management

Job description

Location: Avera Downtown Building-Sioux Falls Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $30.75 - $46.00

Position Highlights

You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

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
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) Upon Hire
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Upon Hire
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) Upon Hire
• Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) Upon Hire
• Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) Upon Hire
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) Upon Hire
• 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

• 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.