United States Job Openings

Prisma Health

Coding Compliance Auditor Sr, Corporate, FT, Day

Columbia

FULL TIME

October 27, 2024

Inspire health. Serve with compassion. Be the difference.

Job Summary
Responsible for assisting in the execution of the annual Quality Coding Assurance Plan. Assists in conducting project planning and developing appropriate audit procedures and conducts audit procedures and reports findings. Coordinates efforts between the Office of Corporate Integrity and Physician Practices of the University Medical Group Administration to improve medical record documentation and overall compliance rates.
Essential Functions
  • All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
  • Independently conducts all project planning procedures for low, moderate and high complexity audits. (Such procedures include determining project scope and objectives, identifying controls, determining "what can go wrong" in a process, and developing appropriate audit procedures to assess controls and address identified risks).
  • Conducts random reviews of coded professional services in accordance with the Prisma Health Quality Coding Assurance Program. Reviews patient medical records and procedures performed in all patient care areas to ensure all policies relating to documentation are followed uniformly. Analyzes results to assess compliance with regulations, identifies procedural weaknesses and education needs that contribute to instances for non-compliance. Ensures that proper billings are issued from individual patient medical records and that all items are justified with proper supporting documents. Report documents findings in well-organized paperwork. Communicates findings and co-develops corrective action plans for the strengthening of internal controls with management of the audited area.
  • Prepares formal written reports summarizing current state (findings), desired future state, and critical success factors (recommendations). Reports are completely accurate, concise, organizationally fluent, and grammatically correct. Applicable Prisma policies or federal/state/agency laws or regulations are referenced and explained. Findings are presented in order of importance and are meaningfully condensed and presented in the Executive Summary. Conducts closing meetings with all levels of management for projects of low-to-medium complexity and participates with a Coordinator directing, in closing meetings for highly complex projects. Exhibits confident and competent verbal communication skills. Concisely presents findings and recommended corrective action plans. Cites and summarizes applicable policies, laws or regulations.
  • Continuously gains knowledge of CPT, ICD, HCPCS and business/industry/legislative issues relating to and impacting Quality Coding Audit and Compliance issues. Increases knowledge by working with Internal Audit, Corporate Compliance, CDI, and HIM to gain experience required for advancing self and the organization.
  • Assists Coordinator in training other auditors and new staff members through leading projects and working together to complete projects.
  • Performs other duties as assigned.
Supervisory/Management Responsibilities
  • This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements
  • Education - Job related course work beyond high school. Medical Terminology, Certified Professional Coder Course.
  • Experience - Six (6) years in CPT, ICD-9/10 and HCPCS coding AND two (2) years in auditing and coding compliance.
In Lieu Of
  • NA

Required Certifications, Registrations, Licenses
  • CPC - CERT PROFESSIONAL CODER
  • CPMA - CERT PROF MED AUDITOR

Knowledge, Skills and Abilities
  • Physician ICD-9/10 and CPT coding experience
  • Evaluation and Management Auditing and Healthcare Compliance experience
  • Microsoft Excel, Power Point and Word

Work Shift
Day (United States of America)
Location
15 Medical Park Rd Richland
Facility
7001 Corporate
Department
70019700 Compliance
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

New Job Alerts
Kampgrounds Of America

YEL - MAINTENANCE ENGINEER

West Yellowstone

November 19, 2024

View Job Description
Anytime Fitness - Milwaukee, WI

Anytime Fitness - Personal Training Manager

Milwaukee

November 19, 2024

View Job Description
ValidaTek, Inc.

Senior Program Manager

Kearneysville

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Preschool Bus Driver

Southaven

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Seasonal Teacher

Alpharetta

PART TIME

November 19, 2024

View Job Description
State of Colorado Job Opportunities

Data and Technology Governance Manager

Denver

FULL TIME

November 19, 2024

View Job Description
PowerSchool Group LLC

Senior Account Manager, Strategic Sales TEXAS

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Preschool Lead Teacher

North Aurora

FULL TIME

November 19, 2024

View Job Description
University of Missouri Health Care

NURSE TECH FULL-TIME NIGHTS - FLOAT POOL

Columbia

FULL TIME

November 19, 2024

View Job Description
Atlas Copco Compressors LLC

Industrial Equipment Sales Representative

Richmond

November 19, 2024

View Job Description
Looking for similar job?
Cincinnati Children's Hospital

Medical Coding Analyst

Cincinnati

FULL TIME

November 19, 2024

View Job Description
Genesis HealthCare System

Coding Specialist I

FULL TIME

August 29, 2024

View Job Description
Netsmart Technologies

Coding & OASIS Reviewer

PART TIME

September 3, 2024

View Job Description
Sanford Health

Coding Verifier

FULL TIME

October 14, 2024

View Job Description
Cook Children's Health Care System

Certified Coding Specialist I

FULL TIME

November 9, 2024

View Job Description
Dazzling Minds Academy

Unity Coding Instructor

PART TIME

October 24, 2024

View Job Description
See What’s New: Prisma Health Job Opportunities
Prisma Health

Radiology Scheduling Support Analyst, FT, Day

Greenville

FULL TIME

November 14, 2024

View Job Description
Prisma Health

Unit Secretary - PRN

Easley

PART TIME

October 27, 2024

View Job Description
Prisma Health

Coding Compliance Auditor Sr, Corporate, FT, Day

Columbia

FULL TIME

October 27, 2024

View Job Description
Prisma Health

Children's Pharmacy- FT Certified Pharmacy Technician

Columbia

FULL TIME

October 27, 2024

View Job Description
Prisma Health

Materials Logistics Coord

Simpsonville

October 24, 2024

View Job Description
View More Jobs by Prisma Health
New Job Alerts
Kampgrounds Of America

YEL - MAINTENANCE ENGINEER

West Yellowstone

November 19, 2024

View Job Description
Anytime Fitness - Milwaukee, WI

Anytime Fitness - Personal Training Manager

Milwaukee

November 19, 2024

View Job Description
ValidaTek, Inc.

Senior Program Manager

Kearneysville

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Preschool Bus Driver

Southaven

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Seasonal Teacher

Alpharetta

PART TIME

November 19, 2024

View Job Description
State of Colorado Job Opportunities

Data and Technology Governance Manager

Denver

FULL TIME

November 19, 2024

View Job Description
PowerSchool Group LLC

Senior Account Manager, Strategic Sales TEXAS

FULL TIME

November 19, 2024

View Job Description
Cadence Education

Preschool Lead Teacher

North Aurora

FULL TIME

November 19, 2024

View Job Description
University of Missouri Health Care

NURSE TECH FULL-TIME NIGHTS - FLOAT POOL

Columbia

FULL TIME

November 19, 2024

View Job Description
Atlas Copco Compressors LLC

Industrial Equipment Sales Representative

Richmond

November 19, 2024

View Job Description