Healthcare Coding Compliance Auditor & Educator

Baylor Scott & White Health; Pierre (SD); On-site; USD 63,000 - 95,000; Full time

Job summary

Baylor Scott & White Health in Pierre, SD is seeking a Provider Coding Compliance Consultant to support the compliance program. The role reports to the Coding Compliance Manager and collaborates with the Compliance Vice President or Director to develop and maintain BSWH policies ensuring adherence to federal, state and local laws.

Responsibilities include identifying audit projects, conducting audits of provider services, producing reports, and obtaining corrective action plans.

Qualifications

• Experience auditing provider services across multiple specialties.
• Strong CPT/ICD-10-CM/HPCS and payer rules knowledge.
• Ability to identify risks and document findings clearly.
• Strong communication and education delivery to providers.

Responsibilities

• Identifies appropriate projects for audits and schedules audits with appropriate personnel.
• Conducts auditing of provider services, monitoring, and investigating activities for compliance.
• Provides written audit reports with risks and recommended corrective steps.
• Obtains corrective action plans and ensures effective implementation.
• Tracks audit findings and surveys auditing effectiveness.
• Coordinates coding education with providers on audit trends and compliance.
• Serves as coding compliance resource to BSWH departments.

Skills

CPT knowledge

ICD-10-CM knowledge

CMS regulations

Payer-specific billing knowledge

Auditing experience

Critical thinking

Education

Bachelor's in HIM or 4 years of Physician/Professional fee coding work experience

HCCA Certification

Tools

Microsoft Word

Microsoft Excel

Job description

Baylor Scott & White Health in Pierre, SD is seeking a Provider Coding Compliance Consultant to support the compliance program. The role reports to the Coding Compliance Manager and collaborates with the Compliance Vice President or Director to develop and maintain BSWH policies ensuring adherence to federal, state and local laws.

Responsibilities include identifying audit projects, conducting audits of provider services, producing reports, and obtaining corrective action plans.