Coding Auditor

Duties and Responsibilities

Essential Functions:

• Performs proactive or reactive coding compliance reviews as needed to identify or quantify potential issues.
• Investigates and recommends action to be taken when compliance issues are found. Monitors implementation of recommended corrective action and performs follow up reviews where necessary.
• Assists with coding compliance implementation throughout the WellSpan.
• Assists in the development and dissemination of education and training processes for the employees regarding coding compliance related activities.
• Assists with any investigations in accordance with the investigation protocol established by the organization.
• Assists in responding to questions, issues, concerns and reports of possible coding or billing misconduct reported or identified through the coding hotline, Help Desk calls, or other reporting lines.
• Supports the organization's commitment to comply with all federal, state, and local standards, with an emphasis on prevention of fraud and abuse.
• Promotes and adheres to the Code of Conduct and the elements of the Compliance Program and exercises due diligence to ensure compliance with policies and legal requirements.
• Prepares written reports pertaining to determinations and recommendations resulting from routine audits and/or assigned special projects. Presents report to appropriate managers and boards.
• Provides guidance to Enterprise Applications for documentation, coding and billing, including the creation of system billing edits.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Maintains appropriate records, reports, and files as required.
• Participates in administrative staff meetings and attends other meetings as assigned.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Travel Requirements:

• Estimated Amount: - Travel required.