The Coding & Compliance Auditor performs detailed, retrospective chart audit review, comparing medical documentation with paid charges. The Coding & Compliance Auditor III is a liaison and resource between Quality and Safety and internal providers, working collaboratively with a diverse group, including management, physicians, clinical and non-clinical personnel. While verifying hospital charges on paid claims, the auditor utilizes the National Healthcare Billing Audit Guidelines and industry standard coding rules.
COMPETENCIES AND SKILLS:
Demonstrates knowledge of all healthcare standard code (CPT4, ICD-10, HCPCS).
Demonstrates strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
Demonstrates the ability to work independently and as a member of a team.
Detail oriented with strong analytical and problem-solving skills.
Demonstrates the ability to successfully plan, organize and manage projects.
Demonstrates excellent proof reading and editing skills.
Proficient presentation skills. Ability to work well under pressure and respond to changing needs and complex environments.
Demonstrates strong working knowledge of Microsoft Office products.
Demonstrates the ability to compile, format, analyze, and present data to a variety of individuals, including hospital representatives, physicians, and management.
EDUCATION AND/OR EXPERIENCE:
LPN, RHIT or Associate's Degree in Health Care, Business, or related field required.
Minimum of five or more years of experience in a managed care or hospital environment in a claims processing, auditing, billing role, and experience reviewing claims, is required.
Minimum 11 years of experience in managed care or hospital environment in a claims processing, auditing or billing role, including three or more years of experience reviewing claims, is required. CPC or CCS certification required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Ability to travel to providers, as assigned.
Ability to work during peak periods.
Work is normally performed in a typical interior/office work environment.
Occasional bending and lifting up to 20 lbs may be required.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
One of the nation’s most innovative health services organizations, Geisinger serves more than 1.5 million patients in Pennsylvania and New Jersey. The system includes 13 hospital campuses, a nearly 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. A physician-led organization, with approximately 32,000 employees and more than 1,800 employed physicians, Geisinger leverages an estimated $12.7 billion positive annual impact on the Pennsylvania and New Jersey economies. Repeatedly recognized nationally for integration, quality and service, Geisinger has a long-standing commitment to patient care, medical education, research and community service. For more information, visit geisinger.org or connect with us onFacebook, Instagram, LinkedInand Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.