[Hiring] Sr Coding Compliance Auditor @CommonSpirit Health

Role Description

As our Auditor, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility.

• Conduct comprehensive audits of financial records, processes, and regulatory compliance.
• Identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws.
• Combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations.
• Demonstrate sharp attention to detail and the ability to communicate complex findings persuasively.
• Transform audit insights into tangible improvements.
• Perform prospective and concurrent chart reviews to ensure documentation is complete and compliant.
• Work to resolve claims denials and report denial trends to leadership.
• Demonstrate analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation.
• Follow department policies and guidelines on appropriate documentation to billing codes.
• Partner with the quality team, clinically integrated network, and payers as necessary to identify trends and gaps for creating a better process.
• Assist in the development and reporting of HCC and Pay for Performance metrics.

Qualifications

• Five years physician coding experience.
• Certified Rehabilitation Counselor, within 12 months.
• Certified Professional Coder Hospital Apprentice, upon hire.
• Certified Professional Coder Apprentice, upon hire.
• Certified Coding Associate, upon hire.
• Cardiology Coding, upon hire.
• Certified Coding Specialist, upon hire.
• Certified Coding Specialist - Physician Based, upon hire.
• Certified Cardiovascular and Thoracic Surgery Coder, upon hire.
• Certified Health Care Compliance, upon hire.
• Certified Interventional Radiology Cardio Coder, upon hire.
• Certified Professional Coder, upon hire.
• Certified Professional Coder Hospital, upon hire.
• Radiology Certified Coder, upon hire.
• Registered Health Information Administrator, upon hire.
• Registered Health Information Technician, upon hire.

Requirements

• Associates Other, upon hire.
• Three years experience performing diagnosis, E/M, and procedure code audit/review/education functions for professional fees in multi-specialty setting.
• Registered Nurse: TN, upon hire.
• Licensed Practical Nurse: TN, upon hire.
• Certified Nursing Assistant: TN, upon hire.
• Certified Professional Medical Auditor, upon hire.