[Hiring] Auditor Coder Specialist @CommonSpirit Health

Role Description

As our Auditor Coder Specialist, 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.
• Perform internal audits and billing compliance reviews to ensure adherence to established quality standards, regulatory requirements, and coding guidelines.
• Review provider E/M profiles, practice patterns, and previous audit findings to identify compliance risks, missed billing opportunities, and areas for improvement.
• Document audit results, track identified risks and trends, and communicate findings and recommendations to appropriate stakeholders.
• Identify educational opportunities and assist with developing training materials and action plans to improve provider documentation, coding accuracy, and billing compliance.
• Respond to coding questions through the Coding Helpline, providing guidance to providers, managers, and billing teams on CPT, ICD-10-CM, reimbursement, regulatory requirements, and documentation standards.
• Review and correct or appeal denied claims as assigned; recommend Epic edits and process improvements to support coding accuracy and compliance.
• Maintain project work lists and auditing software in accordance with established procedures.

Qualifications

• 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.
• Certified Coding Specialist, upon hire or
• Certified Coding Specialist - Physician Based, upon hire or
• Certified Professional Coder, upon hire

Requirements

• Preferred work experience in provider coding/documentation auditing and/or provider training.