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Under the direction of the Coding Quality Assurance & Education Manager, the Quality Assurance Coding Auditor conducts professional, facility, clinic, external vendor, coder, system, and denial coding audits.  The role is responsible for creating, reviewing, and updating department processes, guidelines, and standards in adherence to regulatory changes and organizational compliance laws and regulations. This position will also be responsible for identifying, creating, and providing individual or group education for clinical staff, providers, and coders.  The Quality Assurance Coordinator serves as a liaison with Clinical Departments, Patient Financial Services, Revenue Integrity, clinical staff, and provider relations.

This position is eligible for hybrid work within Iowa and will require a work arrangement form to be completed upon the start of your employment. Per policy, work arrangements will be reviewed annually, and must comply with the remote work program and related policies and employee travel policy when working at a remote location. 

Position Responsibilities:

• Reviews a wide variety of coding policies and procedures to ensure compliance with legal, accreditation, and internal standards. Analyzes existing policies, identifies gaps, and recommends new/revised standards and monitoring methods for departmental use. Reviews detailed departmental processes and policies noting deficiencies.

• Researches and develops materials for educational programs related to all aspects of coding and documentation.

• Designs and implements risk assessments to analyze processes for coding and documentation to identify areas for improvement. Prioritizes risk assessments based on level of the organizational exposure.

• Investigates and responds to audit and denial findings in collaboration with stakeholders. Audits potential issues before they are identified by the regulatory auditors. Coordinates with PCD managers regarding coding changes and other audits.

• Designs and implements audits throughout the organization. Verifies compliance/noncompliance issues against established policies, procedures, applicable laws, and regulations. Facilitates the resolution of noncompliant findings and escalates possible critical issues to QA Manager. Audits may focus on, but are not limited to, documentation, billing, coding, medical necessity, systems, and reimbursement. Analyzes results of assessments for presentation to clinic leadership, providers, compliance, and/or leadership.

Required:

• Bachelor's degree or an equivalent amount of education and experience is required.

• CPC, CCS, COC, RHIT, or RHIA certification is required.

• 3 years of relevant health care coding/billing experience. 

• Knowledge of insurance regulations and Medicare and Medicaid guidelines as related to clinical documentation and clinical indicators.

• Strong problem-solving and research skills. 

• Ability to interpret CMS regulations and guidance.

• Demonstrated ability to provide coding advice to all areas of coding staff, other departments throughout UI Health Care, and other entities as requested.

• Ability to analyze complex clinical scenarios and apply critical thinking. 

• Ability to plan and organize education programs, as well as teach effectively and write education guides and handouts. 

• Experience with EPIC or other electronic medical records system.

• Excellent written, verbal, and interpersonal communication skills.

• Proficiency with MS Word, PowerPoint, and Excel, including database and spreadsheet analysis.

Desired:

• Experience performing coding audits.

• Knowledge of UI Health Care policies and procedures.

Application Process: To be considered, applicants must upload a cover letter and resume (under the submission of relevant materials) that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of 7 calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification.

•  Up to 5 professional references will be requested at a later step in the recruitment process. For questions, contact Sharon Walther at sharon-walther@uiowa.edu.

This position is not eligible for University sponsorship for employment authorization now or in the future.