3464 - SHS CDI PB CODING AUDITOR-PROV SVCS in Chicago, Illinois at Sinai Chicago

See JD Key Responsibilities Perform comprehensive provider-side (professional billing) coding audits for inpatient and outpatient physician services Review and validate E&M levels of service in accordance with current coding guidelines Validate medical necessity based on Medicare, Medicaid, and commercial payer requirements Audit and validate ICD-10-CM, ICD-10-PCS (as applicable), CPT, and HCPCS coding for professional services Evaluate physician documentation to ensure accurate code assignment and appropriate level of care Conduct charge validation, charge entry review, and charge correction recommendations Identify documentation gaps, coding discrepancies, and compliance risks Provide real-time and retrospective provider education to improve documentation and coding practices Collaborate with CDI, Revenue Cycle, Compliance, and Billing teams to ensure alignment Review and interpret Explanation of Benefits (EOBs) and assist with coding-related denial resolution Support denial prevention initiatives and revenue integrity strategies Ensure compliance with HIPAA regulations and organizational policies Utilize Epic EMR and related systems for audit workflows and reporting Participate in internal audits, quality reviews, and performance improvement initiatives Maintain detailed audit documentation, reporting, and productivity metrics