Solid Organ Transplant Coding Auditor

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

The position audits and reports on the accuracy of procedural billing, payment consideration and accuracy in reimbursement based on the correct interpretation and application of codes, modifiers and payment rules. The incumbent reviews and audits physician and institutional billing from multiple departments and entities across the organization, and assists in training departmental personnel in correct coding and documentation. This position is not responsible for providing patient care.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Performs audits and reports on the accuracy of procedure coding, facility E&M coding, ICD-10 coding and billing.
• Reviews insurance payments for reimbursement accuracy, which is based on correct interpretation of clinical data and application of codes, modifiers and payment rules.
• Reviews and audits institutional coding and billing from multiple departments and entities across the organization.
• Assists in training personnel in correct documentation processes and coding guidelines.
• Oversees on-going projects that are within the scope of this position.

Knowledge / Skills / Abilities

• Extensive knowledge of coding rules as outlined by CMS, AHA AMA.

• Ability to identify areas or items which are not in compliance with the rules, present findings to various groups (e.g. physicians, nurses, administrators/directors coders, billing representatives) and recommend appropriate changes to policies and procedures.

• Ability to meet the American Academy of Procedural Coders and/or AHIMA's continuing education requirements.

Qualifications

Required

One of the following:

• RHIA certification and two years of coding experience in multiple specialties.
• RHIT or CPC certification and four years coding experience in multiple specialties.
• Bachelor's degree in a health sciences related area, and four years coding experience in multiple specialties.

Qualifications (Preferred)

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Preferred:

• Knowledge of inpatient and outpatient transplant / speciality related billing, claims, coding, review
• Knowledge of transplant and medicare cost reporting

Physical Requirements