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General Summary

Performs clinical documentation audits, evaluations and other reviews for the System to ensure and assess compliance with applicable laws and regulations. Prepares and presents written and oral reports summarizing audit work, issues identified and recommendations to correct issues to management. Develops and disseminates education and training programs to employees.

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.

Qualifications

Minimum Education:

+ Associates Degree Required

Work Experience:

+ 3 years Coding/Auditing experience. Required

Licenses:

+ Certified Professional Coder Upon Hire Preferred or

+ Certified Coding Specialist Upon Hire Preferred or

+ Certified Coding Specialist - Physician Based Upon Hire Preferred

Knowledge, Skills, and Abilities:

+ Extensive knowledge of ICD-9/ICD-10 and CPT coding principles and guidelines.

+ Excellent written/oral communication and computer skills.

+ Works effectively in a team environment.

Quality of Life

Located in Lewisburg, Pennsylvania, WellSpan Evangelical shares its picturesque, riverside home with Bucknell University-providing access to the arts, entertainment and sporting events while maintaining a small-town setting.

The local school district ranks among the best in the state in academics, athletics and the arts. Despite its tranquil, rural setting, Lewisburg is just three hours from New York City and Philadelphia and four hours from Pittsburgh.

The region is home to the majestic Susquehanna River. We are also surrounded by state parks, scenic country roads, abundant fishing streams and year-round recreational opportunities. The region also offers a number of land and water trails. Photo Courtesy Susquehanna River Valley Visitors Bureau/VisitCentralPA.org

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.