Coding Internal Auditor

Position Purpose

The Coding Internal Auditor provides support to the organization by evaluating the adequacy and effectiveness of internal controls, risk management, and governance processes for Renown Health and related entities. This position will also assist with any audit preparations including internal, external, and Federal/State audits. The internal audit function is located under the department of Audit and Compliance.

The position is responsible for the coordination of coding audits with coding departments, physician departments, Revenue Cycle, and/or additional stakeholders. The emphasis of this position is to coordinate all aspects of audit entities, including outside request for compliance and billing, including and not limited to Recovery Audit Contractor and/or other auditing programs requests.

This position is responsible for keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-10-CM diagnostic, procedure codes and E/M levels for all aspects of facility or professional coding.

Facility Coding Internal Auditors are responsible but not limited to auditing, Acute Inpatient/Outpatient, Level II Trauma, Rehab Facility, Home Health, Hospice, Ambulatory, and hospital-based outpatient areas. ICD-10-CM/PCS, CPT, and E/M code and DRG assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

Professional Coding Internal Auditors are responsible but not limited to auditing, Renown Primary Care and Specialty Care Groups, Acute Inpatient/Outpatient, Trauma, and Inpatient Rehab. ICD-10-CM, CPT, HCPCS, E/M code assignments and modifiers must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

Nature and Scope

Coding Internal Auditors will execute and prepare reports for financial, operational, compliance, internal control and information systems audits and evaluations; provide external audit assistance, and complete special projects, as requested, at the direction of the Manager of Internal Audit and Coding. This position will assist in evaluating the effectiveness of the company's internal controls, risk management processes, and compliance with applicable regulations, as well as reporting and performing tracking and follow-up on all management and/or corrective action plans from those audits.

The incumbent is responsible for auditing information coded from provider documentation and patient medical records to validate coding accuracy for services rendered and to promote compliance.

This position must be objective and independent of the activity being reviewed. It is authorized to have free and unrestricted access to organization functions, records, property, and personnel.

1. Possess strong interpersonal and presentation skills; effective oral and written communication with both internal and external contacts, which clearly and effectively convey project objectives, evaluations, conclusions, and recommendations; understanding of human relations; maintaining satisfactory relationships with project clients.

2. Proficient knowledge of risks and controls for various financial cycles in an organization.

3. Demonstrate curiosity, analytical and problem-solving skills.

4. Maintain absolute confidentiality.

5. Ability to apply knowledge and address situations appropriately without extensive recourse to technical research in the following areas: Internal audit standards, procedures, and techniques; accounting principles and techniques; and management principles.

6. Participate in the annual Internal Audit risk assessment and compliance audit reviews.

7. Investigate and resolve fraud and theft issues.

8. Proficient in the use of word processing and spreadsheet computer programs and various office equipment.

9. Willing to increase level of technical competence specific to the organization and the health care industry.

10. Ability to manage multiple projects simultaneously; Proficiency in time management.

11. Proficient in report writing and communications in all areas of the organization.

12. Motivate and encourage others to enhance teamwork.

13. Responsibility for maintaining coding certification and continuing education.

14. Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’ Official Guidelines for Coding and Reporting ICD-10-CM coding.

15. Expert knowledge of Anatomy and Physiology of the human body, Pharmacology, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.

16. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers.

17. Knowledge of clinical content standards.

18. Ability and knowledge of the appeal process to ensure accurate reimbursement.

19. Uphold a strong work ethic characterized by honesty and dependability.

20. Demonstrate personal time management skills, including organization, prioritization, and multitasking.

21. Adherence to company policies, procedures, and directives.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and/or Preferred