Provider Services Auditor

St. Luke's University Health Network•Allentown, PA

21h•Hybrid

About The Position

The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for professional services billed by providers employed with St. Luke’s Physician Group (SLPG). In doing so, works with providers and their office staff, as well as the Coding and SLPG Billing Department.

Requirements

High school diploma or equivalent required.
Working knowledge of ICD-9, CPT, and HCPCS coding required.
At least 2 years of healthcare experience with background and competency in coding and documentation.
State and Federal regulatory requirements including Medicare, Medicaid and third-party payers as well as strong written/verbal communications skills preferred.
Strong computing and data management abilities, analytical, and interpersonal and communication skills which are all essential skills.
Microsoft office skills to include word, Excel and Power Point Presentations.

Nice To Haves

Certification of CPC, CCS, or CCS-P highly desired OR Coding certification within one year.

Responsibilities

Perform quality audits to include reviewing medical record documentation for completeness and accuracy to support billed claims.
Generate provider reports through billing software.
Coordinates, schedules, and meets with providers to perform education for the professional service documentation and coding audits of both office and in-patient medical records.
Maintain and record audits in Excel spreadsheet format and through an auditing software program.
Is a resource to the coding department, SLPG practices, providers, and billing department.
Assisting with the development of training materials for compliance education and training modules.
Provides training classes to new providers throughout the year along with providing education to the Residency programs.
Maintain current knowledge of coding and documentation educational updates for primary care and specialty services.
Assists in the formulation and review of Network policies and guidelines affecting the coding of professional services.
Assists in maintaining the FY audit plan and accurate accounting of time allocated to each audited provider.
Analyzing data in Excel or other software programs and making sound recommendations based on the results.