SINAI CHICAGO COMPLIANCE CODING AUDITOR at Sinai Chicago – Chicago, Illinois

About Us:

At Sinai Health System d/b/a Sinai Chicago, we take health care personally. Excellence in health care is about more than just medicine, technology, tests, and treatments, it is about really caring for people with dignity and respect. That is what we do. We are dedicated to providing the best care to meet the needs of people, for our community, for our patients and for you.

Position Purpose:

The Compliance Coding Auditor will report to the Chief Compliance Officer and will assist in maintaining

Compliance with CMS, OIG, and internal coding and billing compliance guidance as dictated by the SMG Coding and Billing Compliance Plan. This individual will be responsible for performing compliance audits on physician charts, provide an accounting of all audits and assess the controls in place to assure that audits are accurate and effective. This individual will also provide education to all new providers and administer yearly education to existing providers. While reporting to the Chief Compliance Officer, this position will maintain a close relationship with Revenue Cycle and the Health Information Management department including the coding team. Finally, this individual will serve on the All Payer Response team and will be responsible for reacting and responding to all government inquiries, requests, and audits.

Education and Work Experience:

• Bachelor’s degree
• Eight plus years of experience with coding and/or billing in health care revenue cycle. This should include hospital and physician practice.

Knowledge and Skills:

• Ability to function independently and as a team player in a fast-paced environment required.
• Knowledge of inpatient and DRG coding.
• Knowledge of computing observation hours.
• Knowledge of coding infusions and injections.
• Knowledge of surgical coding.
• Knowledge of Evaluation and Management coding.
• Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
• Knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).