[Hiring] Coding Audit Specialist @Sanford Health

Role Description

The Coding Audit Specialist position conducts quality assurance activities to ensure the accuracy and integrity of risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and Department of Health Services (DHS); identifies deficiencies and provides management with an analysis of outcomes and tools for improving accuracy in coding.

• Responsible for auditing medical record documentation to determine appropriate diagnostic coding for services provided.
• Develops, implements, and monitors a continuous monitoring program for Medicare Advantage risk adjustment scores, ACA/Exchange, and Medicaid/BadgerCare Plus member diagnosis documentation.
• Audits medical record documentation to ensure correct codes have been selected and to detect un‐coded or miscoded diagnoses.
• Maintains knowledge of CPT coding rules, ICD‐9 and ICD‐10 codes, HCPCS codes, HCC coding, use of modifiers, documentation guidelines, CMS Policy requirements, and other reimbursement guidelines.
• Reviews components of the provider's documentation and compares it with the requirements of the code(s) reported.
• Formulates an outcome for each audit and identifies correct or incorrect coding to ensure audit findings are presented in a logical, concise summary.

Qualifications

• High school diploma or equivalent required.
• Demonstrated knowledge of anatomy/physiology and medical terminology.
• Completion of courses in Current Procedural Terminology and ICD‐9 and ICD‐10 coding required.
• Associate Degree in coding and/or health‐related field preferred.
• Three years of experience required in a health insurance, compliance, quality assurance, or auditing related position.
• Experience with ICD‐9, ICD‐10, CPT, HCC, and HCPCS coding.
• Knowledge of the different CMS guidelines that affect Medicare Advantage, HHS‐ACA, and DHS/BadgerCare Plus members as related to revenue management.
• Demonstrated knowledge of Word, Excel, and Access.
• Certified Professional Coder and/or Certified Risk Adjustment Coder certification awarded by American Academy of Professional Coders required within one year of hire.

Requirements

• Must be able to work 40 hours per week.
• Work shift: Day (United States of America).
• Salary Range: $21.50 - $34.50.
• Union Position: No.

Company Description

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.