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St. Charles Health System
Hospitals & Health Care
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ST. CHARLES HEALTH SYSTEM
JOB DESCRIPTION
TITLE: Ambulatory Services Auditor and CDS I
REPORTS TO POSITION: System Revenue Integrity Director
DEPARTMENT: Revenue Integrity
DATE LAST REVIEWED: May 2023
OUR VISION: Creating America’s healthiest community, together
OUR MISSION: In the spirit of love and compassion, better health, better care, better value
OUR VALUES: Accountability, Caring and Teamwork
DEPARTMENTAL SUMMARY: The Revenue Integrity department provides many services to our multi-hospital and medical group organization focusing on the patient financial experience along the entire continuum of care. Our goal is to deliver a delightful, transparent, and seamless experience to our patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner.
POSITION OVERVIEW: The Ambulatory Services Auditor and Clinical Documentation Specialist I is responsible for conducting audits of outpatient, inpatient and ambulatory service medical documentation across St. Charles Health System to ensure compliance with ICD-10-CM and CPT-4 coding regulations, rules, and guidelines. This position will also provide education, feedback, and guidance to multiple parties, as needed. This position does not directly manage any other Caregivers.
ESSENTIAL FUNCTIONS AND DUTIES:
Conduct system-wide pre- visit or post-visit chart reviews of professional services to include both hospital and clinic/office settings of care.
Audit and monitor all lines of system business for coding, to include outpatient, inpatient and ambulatory services.
Perform audits on/for the HIM Professional Services Coding team and provide feedback and education as needed to ensure compliance with quality coding standards.
Evaluate medical records to ensure the accuracy of clinical documentation to support the acuity of the patient, risk profiles for HCC capture and recapture, and diagnostic and procedural code integrity in compliance with ICD-10-CM and CPT-4/HCPCs rules and guidelines.
Develop and update procedure manuals to maintain standards for correct coding.
Assist in conducting system-wide education and training in coding of professional services.
Assist in setting the direction for coding compliance and education.
Assist in providing technical guidance to physicians and other departmental staff in identifying and resolving issues such as incomplete or missing records, or codes that do not conform to approved coding guidelines.
Recommend process changes and improvements within departmental and operational policies and procedures or system changes to reduce losses or improve efficiency.
Monitor trends and prepare reports on such topics as documentation or coding issues and denied claims, for review by senior auditors and or management.
Supports the vision, mission, and values of the organization in all respects.
Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
Provides and maintains a safe environment for caregivers, patients, and guests.
Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate.
May perform additional duties of similar complexity within the organization, as required or assigned.
EDUCATION
Required: High school diploma or GED
Preferred: Associates degree in Health Information Technology or related field
LICENSURE/CERTIFICATION/REGISTRATION
Required: RHIA, RHIT, CCS-P, CPC, CPMA, CRC, RN, or LPN
Preferred: CPMA CRC, RN, LPN
EXPERIENCE
Required: 0-3 years of coding experience required, or an equivalent combination of education and experience. Knowledge of current Medicare regulations, including, MPFS, IPPS and OPPS.
Preferred: Inpatient, Outpatient, and Ambulatory services coding preferred. Physician Evaluation and Management coding experience preferred.
PERSONAL PROTECTIVE EQUIPMENT
Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
ADDITIONAL POSITION INFORMATION:
PHYSICAL REQUIREMENTS:
Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.
Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing.
Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle.
Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level.
Exposure to Elemental Factors
Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface.
Blood-Borne Pathogen (BBP) Exposure Category
No Risk for Exposure to BBP
Schedule Weekly Hours:
40Caregiver Type:
RegularShift:
First Shift (United States of America)Is Exempt Position?
YesJob Family:
AUDITORScheduled Days of the Week:
Monday-FridayShift Start & End Time:
07:00-15:00After you apply, unlock the direct contact details of the people who actually make the call. A quick follow-up makes you 5x more likely to land an interview.
Marcus Rivera
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St. Charles Health System
St. Charles Health System
St. Charles Health System
