Coding & Reimbursement Auditor

Avera•Sioux Falls, SD

11h•Onsite

About The Position

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.

Requirements

The individual must be able to work the hours specified.
Visual acuity adequate to perform position duties.
Ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
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.

Nice To Haves

Bachelor's in Health Information Management or related field.

Responsibilities

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.