Auditor Coder Specialist

In 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.

Job 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.

Education/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.