Coding Auditor

Coding Auditor

Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.

At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness –

• Lifestyle Engagement
• Access & Affordability

The Coding Auditor performs coding quality audits of records to ensure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education needs for providers and coding team members. Monitors for compliance with regulatory requirements and works closely with corporate compliance. Provides feedback and education to coders when discrepancies and areas of opportunity are identified through auditing and payer denial review.

Key Accountabilities:

• Performs compliance monitoring and auditing of billing, coding, and documentation related to inpatient, outpatient surgery, observation, emergency department, urgent care, and professional services for all payers to ensure compliance with regulatory requirements.
• Reviews and prepares compliance audit reports to ensure ThedaCare meets coding accuracy standards that are set in place.
• Assists in the preparation and response to external oversight agency and commercial payer audits and inquiries including CMS, Medicaid, RAC, HRSA, and PERM to ensure appropriate reimbursement. Reviews internal processes to ensure compliance with regulatory requirements.
• Responds to identified areas of risk through investigation and internal audit to ensure compliance with regulatory requirements.
• Assists in the preparation and execution of the annual audit plan as part of the corporate compliance plan.
• Assists in monitoring and responding to corporate compliance hotline reports related to hospital coding.
• Stays current with changing regulatory requirements through review of periodicals, compliance association newsletters, and review of state and federal regulatory agency work plans to ensure compliance.
• Assists in the development and management of learning management systems and compliance training materials to ensure compliance with regulatory requirements.
• Serves as subject matter expert to educate coders, providers, and others regarding documentation requirements for accurate coding.
• Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations. Obtains clarification of conflicting, ambiguous, or non-specific documentation to ensure compliance with regulatory requirements.
• Trains, instructs, and/or provides technical support to medical providers as appropriate regarding coding compliance documentation, regulatory provisions, and third party payer requirements to ensure compliance with regulatory requirements.
• Maintains working knowledge of changes and requirements related to compliance/regulations and coding.

Qualifications:

• High School diploma or GED preferred
• Minimum three years of experience in hospital coding
• Minimum two years of experience in clinical medical audit review
• Current or obtained within one year of hire – Certified Coding Credential obtained through AHIMA or AAPC, or RHIT (Registered Health Information Technologist/AHIMA), or RHIA (Registered Health Information Administrator/AHIMA). Minimum certification requirement is one of the following: CCS (Certified Coding Specialist/AHIMA), CPC (Certified Professional Coder/AAPC), CIC (Certified Inpatient Coder/AAPC), or COC (Certified Outpatient Coder/AAPC).
• Current or obtained within one year of hire – Certified Clinical Documentation Specialist obtained through Association of Clinical Documentation Integrity Specialists (ACDIS)

Physical Demands:

• Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

Work Environment:

• Normally works in climate controlled office environment
• Frequent sitting with movement throughout office space
• Use of computers throughout the work day
• Frequent use of keyboard with repetitive motion of hands, wrists, and fingers

Position requires compliance with department specific competencies.

Scheduled Weekly Hours: 16

Scheduled FTE: 0.4

Location: ThedaCare Regional Medical Center - Appleton - Appleton, Wisconsin

Overtime Exempt: No

Worker Shift Details: Days