Coding Auditor

Living A Life Inspired! Our new vision at Theda Care is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.

At Theda Care, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with Theda Care.

• Benefits, with a whole-person approach to wellness – Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
• Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare

Summary :
The Coding Auditor performs coding quality audits of records to ensure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education needs for providers and coding team members. Monitors for compliance with regulatory requirements and works closely with corporate compliance. Provides feedback and education to coders when discrepancies and areas of opportunity are identified through auditing and payer denial review

• Performs compliance monitoring and auditing of billing, coding, and documentation related to inpatient, outpatient surgery, observation, emergency department, urgent care, and professional services for all payers to ensure compliance with regulatory requirements.
• Reviews and prepares compliance audit reports to ensure Theda Care meets coding accuracy standards that are set in place.
• Assists in the preparation and response to external oversight agency and commercial payer audits and inquiries including CMS, Medicaid, RAC, HRSA, and PERM to ensure appropriate reimbursement.
• Reviews internal processes to ensure compliance with regulatory requirements.
• Responds to identified areas of risk through investigation and internal audit to ensure compliance with regulatory requirements.
• Assists in the preparation and execution of the annual audit plan as part of the corporate compliance plan.
• Assists in monitoring and responding to corporate compliance hotline reports related to hospital coding.
• Stays current with changing regulatory requirements through review of periodicals, compliance association newsletters, and review of state and federal regulatory agency work plans to ensure compliance.
• Assists in the development and management of learning management systems and compliance training materials to ensure compliance with regulatory requirements.
• Serves as subject matter expert to educate coders, providers, and others regarding documentation requirements for accurate coding.
• Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations.
• Obtains clarification of conflicting, ambiguous, or non‑specific documentation to ensure compliance with regulatory requirements.
• Trains, instructs, and/or provides technical support to medical providers as appropriate regarding coding compliance…