Providence Health & Services Coding Compliance Auditor PSJH in Portland, Oregon
Providence St. Joseph Health is calling a Coding Compliance Auditor PSJH to our location in Renton, WA.
We are seeking a Coding Compliance Auditor who will perform highly complex and detailed coding compliance auditing and will serve as a valued resource to all regions leadership, physicians and advanced care providers. This position will need to work closely with the regional leadership teams, regional compliance leadership & compliance personnel, as well as all physicians, advanced care providers, and coding staff in all regions of Providence St. Joseph Health. The Revenue Cycle Compliance (RCC) Coding Accuracy & Integrity Auditor is critical to the coding & billing compliance program. By performing Provider/Coder compliance audits, Integrity Hot Line Complaints, DLA and adhoc risk requests of Professional Billing and coding throughout PSJH enterprise wide and staying current with official coding guidelines and regulations, the incumbent ensures the proper coding and billing of supportive documentation within the medical records. This position includes obtaining, recording and reporting essential data, assisting in problem solving of coding issues and acting as a subject matter expert for system leaders, regional complaince, providers & coding staff. The incumbent performs all duties in a manner that promotes the Providence mission, values, and philosophy. In all aspects, the incumbent serves as a role model for the values and mission of the organization.
In this position you will have the following responsibilities:
Proven thorough knowledge of ICD-10 and/or CPT coding/charging principles and conventions, medical terminology, anatomy and physiology, human disease processes prospective payment systems (DRGs) and Present on Admission (POA) assignment
Effective decision making and problem solving skills involving outpatient and inpatient medical record coding/charging compliance
Demonstrates ownership and accountability of work flows.
Demonstrates ability to partner with RIS & other PSJH Caregivers
Knowledge of CMS, Medicaid and other regulatory guidelines including current E&M documentation and coding/charging rules (for example and not limited to: IV Infusion/Hydration Hierarchy, Observation hours and beside procedures, IRF Admission medical necessity requirements, Behavioral Health/Psych documentation & certification requirements and Pharmacy Single Dose Vial Wastage Modifier and Pharmacy 340B billing rules etc.).
Knowledge of PSJH organizational policies and procedures.
Demonstrates effective analytical, strategic thinking and reporting capabilities.
Familiarity with the impact of coding/charging on national hospital and physician metrics such as Hospital Acquired Conditions, Patient Safety Indicators, Value Based Purchasing, and Core Measures and is able to audit the codes that affect these measures.
Proven analytical ability and ability to audit medical records' coding
A track record in reading and interpreting medical records.
Proven effective and respectful oral and written communication skills including the ability to communicate clearly using medical terms about patient diagnoses and procedures
Demonstrated ability to appropriately resolve and escalate issues.
Proven excellent attention to detail with a focus on quality
Demonstrated knowledge of HIPAA rules and regulations and ability to perform in alignment with company mission and values.
Ability to prioritize incoming tasks assuring business needs are met timely and accurately in a calm professional manner.
Required qualifications for this position include:
Bachelor's Degree or equivalent education/experience.
5 years experience or a combination of healthcare related education & experience in coding & auditing.
Experience in statistical analysis and data audits for all necessary projects, to include analyzing data from report to summarize, draw conclusions and trending of data.
Certified Professional Coder (CPC), CCS, CCS-P and/or ACS-EM or equivalent.
Preferred qualifications for this position include:
Certified Professional Coder - Evaluation and Management Auditing.
Current Coding Auditor credentials (CPMA or CEMC) is preferred OR eligibility to obtain within one year of hire.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer a full comprehensive range of benefits — see our website for details —http://www.providenceiscalling.jobs/rewards-benefits
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Coding
Other Location(s): New Mexico-Hobbs, Alaska-Anchorage, Montana-Missoula, Texas-Lubbock, Oregon-Portland, California-Irvine
Req ID: 326435