Wellstar Health System
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Lead Coding Services Auditor
role at
Wellstar Health System .
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well‑being of every person we serve.
Job Summary The Lead Coding Services Auditor is responsible for conducting prebill and retrospective reviews, including focused reviews on identified opportunities, mortality, PSI and coder focused audits. Reviews include full DRG validation, review of assigned ICD-10-CM/PCS, POA indicator(s), validation of all abstracting elements, review for query opportunities affecting DRG, severity of illness, and/or risk of mortality scores. Auditor will use Vizient risk adjustment tools to identify potential coding opportunities during chart reviews. All audits performed ensure compliance with current coding guidelines and regulatory standards.
The Lead Coding Services Auditor will use critical thinking skills and knowledge of coding/compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to leadership. The Lead Coding Services Auditor serves as a mentor for the auditing team, providing expert level expertise and feedback to the auditing and leadership team.
The Lead Coding Auditor will represent the auditing team in meetings within and outside the department on subject matter within the owning area. The Lead Coding Services Auditor will create and maintain detailed data logs and trends and produce data in a meaningful executive style format for presentation.
Core Responsibilities And Essential Functions Capture of Data and Reporting:
Perform lead duties in support of the team in regard to data and reporting: produce monthly reports and maintain dashboards from multiple systems, maintain other logs and spreadsheets (e.g., CFB email, PSI log), maintain updated data needed by the team (e.g., Vizient Data), update written processes as directed by Data Quality Manager.
Collect and appropriately record data in auditing software and/or spreadsheets (e.g., Cloudmed, EPIC, Institutional Audit Manager, IAM).
Work assignments in accordance with leadership direction, communicate any outstanding negative impacts.
Follow verbal and written processes and instructions.
Communicate messages verbally and via email in a manner to achieve an objective.
Capture troubleshoot on reported IT issues for the team; serve as a superuser for testing and updates for systems utilized by the team.
Perform Prebill and Retrospective Reviews.
Validate assigned ICD-10-CM/PCS codes, abstracting data elements and DRGs are correct/appropriate according to official coding guidelines and supported by clinical documentation in the medical record; perform audits at a minimum accuracy and productivity rate upon completion of audit.
Validate abstracting data: POA, point of origin, admission source, discharge disposition are correct.
Validate adherence to WellStar Coding Policies and Procedures.
Validate adherence to Wellstar Coding Query Policy.
Review and identify coding opportunities on mortality accounts using validation criteria from Vizient Risk Adjustment Calculator tool and other sources.
Identify query opportunities or other documentation improvements on reviews.
Serve as the department PSI (Patient Safety Indicator) subject matter expert for coding abstracting accuracy impact(s) based on AHRQ inclusion and exclusion criteria for PSIs.
Provide verbal and written trending data citing opportunities and feedback for process improvements; lead responsibilities in support of the team in regard to audit reviews, including focused reviews, audit the auditor reviews, rebuttals.
Onboarding, Education Mentoring.
Onboard new Coding and Auditor staff; oversee lead onboarding performed by any outside vendor(s).
Lead communication with internal and external stakeholders relevant to auditing results education plans.
Communicate feedback to Coding CDI leadership as well as Coders on areas of opportunity relevant to coding, abstracting and documentation opportunities.
Participate in creation and roll‑out of action and process improvement plans to address opportunities.
Prepare educational materials, instructions and tip sheets for Coding and CDI teams, as necessary.
Serve as a subject matter expert for owning area, participate in meetings, communicate coding knowledge complexities with internal and external stakeholders including the CDI team.
Review and stay abreast of the latest state and federal regulatory guidelines, official coding guidelines and all coding updates; communicate understanding, impacts, implications for WHS.
Serve as a mentor for the team.
Accurately and completely assign appropriate ICD-10-CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum accuracy rate in accordance with Coding and WHS guidelines.
Accurately and completely abstract all required data into appropriate data fields in compliance with statistical data requirements with a minimum accuracy rate.
Meet productivity standards.
Query physicians to further clarify code assignments, as necessary.
Required Minimum Education Associate’s Degree in Health Information Management, Business, or other health care‑related field (Required). Bachelor’s Degree in Health Information Management, Business, or other health care‑related field (Preferred).
Required Minimum License(s) And Certification(s) All certifications are required upon hire unless otherwise stated.
Cert Coding Spec-Preferred or Reg Health Information Admin-Preferred or Reg Health Information Tech-Preferred.
Required Minimum Experience
Minimum 1 year served in a Coding Auditor Role at Wellstar for at least one year, fully trained and maintains an accuracy in all areas within scope of work (Required).
Minimum 3 years of hospital-based inpatient auditing experience currently meeting an accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by the Coding department, if applicable (Required).
Required Minimum Skills
Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology.
Excellent organizational skills; ability to manage multiple tasks, set priorities and achieve goals timely.
Efficient use of various software systems: EPIC, 3M360, Institutional Audit Manager, Vizient, Cloudmed, Outlook, Teams, and text messaging.
Ability to articulate & communicate verbally & via email, achieve an objective & with critical thinking skills.
Ability to identify creative, out‑of‑the‑box solutions to complex problems, analyze issues and opportunities to achieve and provide feedback and implement solutions for success.
Serve as a mentor to the team, assist and being a source of information and insight; provide an exchange of knowledge, experience and goodwill to assist in growth for the team members.
Previous PSI (Patient Safety Indicator) Auditing Experience Preferred. Medium.
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Accounting/Auditing and Finance
Hospitals and Health Care
Referrals increase your chances of interviewing at Wellstar Health System by 2x
#J-18808-Ljbffr
Lead Coding Services Auditor
role at
Wellstar Health System .
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well‑being of every person we serve.
Job Summary The Lead Coding Services Auditor is responsible for conducting prebill and retrospective reviews, including focused reviews on identified opportunities, mortality, PSI and coder focused audits. Reviews include full DRG validation, review of assigned ICD-10-CM/PCS, POA indicator(s), validation of all abstracting elements, review for query opportunities affecting DRG, severity of illness, and/or risk of mortality scores. Auditor will use Vizient risk adjustment tools to identify potential coding opportunities during chart reviews. All audits performed ensure compliance with current coding guidelines and regulatory standards.
The Lead Coding Services Auditor will use critical thinking skills and knowledge of coding/compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to leadership. The Lead Coding Services Auditor serves as a mentor for the auditing team, providing expert level expertise and feedback to the auditing and leadership team.
The Lead Coding Auditor will represent the auditing team in meetings within and outside the department on subject matter within the owning area. The Lead Coding Services Auditor will create and maintain detailed data logs and trends and produce data in a meaningful executive style format for presentation.
Core Responsibilities And Essential Functions Capture of Data and Reporting:
Perform lead duties in support of the team in regard to data and reporting: produce monthly reports and maintain dashboards from multiple systems, maintain other logs and spreadsheets (e.g., CFB email, PSI log), maintain updated data needed by the team (e.g., Vizient Data), update written processes as directed by Data Quality Manager.
Collect and appropriately record data in auditing software and/or spreadsheets (e.g., Cloudmed, EPIC, Institutional Audit Manager, IAM).
Work assignments in accordance with leadership direction, communicate any outstanding negative impacts.
Follow verbal and written processes and instructions.
Communicate messages verbally and via email in a manner to achieve an objective.
Capture troubleshoot on reported IT issues for the team; serve as a superuser for testing and updates for systems utilized by the team.
Perform Prebill and Retrospective Reviews.
Validate assigned ICD-10-CM/PCS codes, abstracting data elements and DRGs are correct/appropriate according to official coding guidelines and supported by clinical documentation in the medical record; perform audits at a minimum accuracy and productivity rate upon completion of audit.
Validate abstracting data: POA, point of origin, admission source, discharge disposition are correct.
Validate adherence to WellStar Coding Policies and Procedures.
Validate adherence to Wellstar Coding Query Policy.
Review and identify coding opportunities on mortality accounts using validation criteria from Vizient Risk Adjustment Calculator tool and other sources.
Identify query opportunities or other documentation improvements on reviews.
Serve as the department PSI (Patient Safety Indicator) subject matter expert for coding abstracting accuracy impact(s) based on AHRQ inclusion and exclusion criteria for PSIs.
Provide verbal and written trending data citing opportunities and feedback for process improvements; lead responsibilities in support of the team in regard to audit reviews, including focused reviews, audit the auditor reviews, rebuttals.
Onboarding, Education Mentoring.
Onboard new Coding and Auditor staff; oversee lead onboarding performed by any outside vendor(s).
Lead communication with internal and external stakeholders relevant to auditing results education plans.
Communicate feedback to Coding CDI leadership as well as Coders on areas of opportunity relevant to coding, abstracting and documentation opportunities.
Participate in creation and roll‑out of action and process improvement plans to address opportunities.
Prepare educational materials, instructions and tip sheets for Coding and CDI teams, as necessary.
Serve as a subject matter expert for owning area, participate in meetings, communicate coding knowledge complexities with internal and external stakeholders including the CDI team.
Review and stay abreast of the latest state and federal regulatory guidelines, official coding guidelines and all coding updates; communicate understanding, impacts, implications for WHS.
Serve as a mentor for the team.
Accurately and completely assign appropriate ICD-10-CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum accuracy rate in accordance with Coding and WHS guidelines.
Accurately and completely abstract all required data into appropriate data fields in compliance with statistical data requirements with a minimum accuracy rate.
Meet productivity standards.
Query physicians to further clarify code assignments, as necessary.
Required Minimum Education Associate’s Degree in Health Information Management, Business, or other health care‑related field (Required). Bachelor’s Degree in Health Information Management, Business, or other health care‑related field (Preferred).
Required Minimum License(s) And Certification(s) All certifications are required upon hire unless otherwise stated.
Cert Coding Spec-Preferred or Reg Health Information Admin-Preferred or Reg Health Information Tech-Preferred.
Required Minimum Experience
Minimum 1 year served in a Coding Auditor Role at Wellstar for at least one year, fully trained and maintains an accuracy in all areas within scope of work (Required).
Minimum 3 years of hospital-based inpatient auditing experience currently meeting an accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by the Coding department, if applicable (Required).
Required Minimum Skills
Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology.
Excellent organizational skills; ability to manage multiple tasks, set priorities and achieve goals timely.
Efficient use of various software systems: EPIC, 3M360, Institutional Audit Manager, Vizient, Cloudmed, Outlook, Teams, and text messaging.
Ability to articulate & communicate verbally & via email, achieve an objective & with critical thinking skills.
Ability to identify creative, out‑of‑the‑box solutions to complex problems, analyze issues and opportunities to achieve and provide feedback and implement solutions for success.
Serve as a mentor to the team, assist and being a source of information and insight; provide an exchange of knowledge, experience and goodwill to assist in growth for the team members.
Previous PSI (Patient Safety Indicator) Auditing Experience Preferred. Medium.
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Accounting/Auditing and Finance
Hospitals and Health Care
Referrals increase your chances of interviewing at Wellstar Health System by 2x
#J-18808-Ljbffr