Coding Auditor

Responsibilities

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve.

To learn more about IPM visit Physician Services - Independence Physician Management - UHS.

Position Overview

Coder Certification Required.The Coding Auditor is responsible for determining that ICD-10, CPT-4, and HCPCS coding is supported by the clinical documentation in the medical record as well as validating medical necessity per CMS Local Coverage Determination (LCD). Applies working knowledge of medical terminology, anatomy, CPT-4 and ICD-10 codes and coding skills/ experience to ensure timely and accurate audits of clinical documentation as requested.

Key Responsibilities Include

• Performs accurate and timely review of clinical documentation as requested to ensure that ICD-10, CPT-4 and HCPCs coding is supported by the clinical documentation is medical record. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
• Reviews audit samples following CBO IPM policy and utilizing established protocols, audit tools and worksheets to report accurate and timely findings to the Coding Manager. Meets or exceeds established performance targets (productivity and quality) established by the Manager, Coding.
• Assists in educating providers on clinical documentation requirements to support their coding and ensure all coding (charge) possibilities are being captured.
• Provides feedback on audit and education plans and materials and makes recommendations for updates that will enhance the auditing process.
• Maintains an expanded knowledge base CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies. Meets continued education guidelines to maintain current AAPC CPC certification
• Exercises good judgement in escalating identified coding trends that may negatively impact productivity, quality or revenue to enhance clinical documentation to support codes billed, drive consistency across IPM, mitigate claim denials, expedite reprocessing of claims and maximize opportunities to enhance front end, coding-related claim edits to facilitate first pass resolution.
• Participates in regularly scheduled team meetings offering new paths, procedures and approaches to maximize opportunities for performance and process improvement.

Qualifications

High School Graduate/GED required. Associates Degree preferred. 3 -5 years of experience required working in a healthcare (professional) billing, health insurance, coding, auditing or equivalent operations work environment.

• Auditing experience required.
• AAPC CPC Certification required.
• Healthcare (professional) billing, CPT-4 and ICD-10 codes, government, managed care and third party billing guidelines, AMA, AAP, CMS and coding policies.
• Understanding of the revenue cycle and how the various components work together preferred.
• Excellent organization skills, attention to detail, research and problem solving ability.
• Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.
• Service-oriented/customer-centric.
• Strong computer literacy skills including proficiency in Microsoft Office.
• Billing software (e.g., Cerner, Epic, IDX) experience are highly desirable.

As an IPM employee you will be part of a first-class organization offering:

• Excellent Medical, Dental, Vision and Prescription Drug Plans
• Competitive Compensation & Generous Paid Time Off
• 401(K) with company match
• Tuition Reimbursement and much more!

Independence Shared Services is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Shared Services. No fee will be paid in the event the candidate is hired as a result of the referral or through other means.

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $13.4 billion in 2022. During the year, UHS was again rec…