Provider Services Auditor

St. Luke's University Health Network-posted 4 months ago
Entry Level
Allentown, PA
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St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. 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.

  • 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 meet 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.
  • High school diploma or equivalent required.
  • Certification of CPC, CCS, or CCS-P highly desired OR Coding certification within one year.
  • 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.
  • 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.
  • Equal Opportunity Employer
  • Top Workplace recognition in the Lehigh Valley and Philadelphia Region
  • National Top Workplaces recognition by USA Today
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