Auditor Coder Specialist

Auditor Coder SpecialistFranciscan Medical GroupTacoma, WashingtonThe posted compensation range of $25.25 - $36.61 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.Requisition ID 2023-282174 Employment Type Full Time Department Business Office - Coding / Data Entry Hours/Pay Period 80 Shift Day Weekly Schedule Monday-Friday (8:00am-4:30pm) Remote Yes Category Medical CodingOverviewIn 2020, united in a fierce commitment to deliver the highest quality care and exceptional patient experience, Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care, including 11 hospitals and nearly 5,000 physicians and providers. Together, we are empowered to make an even greater impact on the health and well-being of our communities.CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!ResponsibilitiesJob Summary:This job is responsible for auditing internal and external coding documentation to assure appropriate reimbursement in compliance with applicable federal and state laws and the program requirements of federal, state and private health plans. Work includes identifying missed billing opportunities and coordinating the correction or appeal of denied claims.Through the audit process, an incumbent identifies compliance issues (e.g. cloning risks), analyzes practice patterns and recommends appropriate procedural changes or Epic coding edits. An incumbent also maintains the internal auditing software application by entering accurate and complete provider audits and collaborates with other coding staff to share concerns and trends in audit findings. Also fields call from the coding E/M helpline, providing basic information/feedback in response to coding-related questions, concerns and regulations.Work is performed in collaboration with professional peers to ensure effectiveness of the coding education and with coding management to ensure risks are timely identified and prioritized across the revenue cycle function.Essential Duties:

Performs internal audits and billing compliance reviews in accordance with established production and quality measures.

Assesses provider E/M profiles, previous reviews, analyzes practice patterns, identifies missed billing opportunities and assures compliance with all regulatory guidance.

Reviews findings from any past audits (scheduled or non-scheduled) or other sources (e.g. recap e-mails, audit documentation from internal auditing software) that provide relevant training/educational information.

Determines, based on established procedures, the status change of the risk(s) identified from previous audits.

Enters the results of coding audits performed in the internal auditing software application; enters additional information as appropriate to document trends and/or update findings; sends audit results to stakeholders, along with summary of findings.

Corrects or appeals denied claims based on assignment.

Notifies Coding Compliance Auditor/Educator of concerns or findings.

Assists in the development of educational materials based on trends or risk areas and in determining the effectiveness of training provided.

Assists in the development of any action plans to address matters such as minimizing/preventing potential risk, gaining billing opportunities, improving provider documentation, etc.

Makes recommendations for Epic edits and/or process changes.

Answers the Coding Helpline.

Responds to questions from providers, managers, billing office and other stakeholders with official references via email or telephone relating to CPT and ICD-10-CM coding, rules and regulations, reimbursement and documentation requirements.

Maintains project work lists and auditing software application in accordance with established procedures.

Performs related duties as required.

QualificationsEducation/Experience:

Two years of related work experience involving ICD-10-CM and CPT coding in an acute or ambulatory care setting that would demonstrate attainment of the requisite job knowledge/abilities. Work experience in provider coding/documentation auditing and/or provider training is preferred.

License/Certification:

Coding certification through AHIMA (CCS, CCS-P) or the AAPC (CPC) is required.

Equal OpportunityCommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed toa diverse and inclusive workforce. All qualified applicants will be considered foremployment without regard to race, color, religion, sex, sexual orientation, genderidentity, national origin, age, disability, marital status, parental status,ancestry, veteran status, genetic information, or any other characteristic protectedby law. For more information about your EEO rights as an applicant,pleaseclick here. (https://tbcdn.talentbrew.com/company/35300/img/v10/EEOCKnowYourRightsEnglish.pdf)CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c).External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA).CommonSpirit Health™ participates in E-Verify.