Senior Encounter Documentation Auditor

Under the direct supervision of the Billing Compliance Manager, the Sr. Encounter Documentation Auditor is responsible for performing audits of encounters to assess the accuracy and integrity of the billing process, preparing comprehensive reports on the results of coding and billing audits and areas for improvement of clinical documentation. This includes meeting with providers and clinical staff to provide education and present results of audits. In addition, this position will be responsible for review of outside audit requests, training of staff and coverage for other positions within the unit.

Job Relationships

Reports to the Billing Compliance Manager

Principal Responsibilities

• Perform the more complex or difficult audits of services with special emphasis on assessment of Evaluation and Management levels assigned to encounters, identifying missed billing opportunities and errors in assignment of CPT codes.

• Develop and review training plans around CMS updates.

• Provide training regarding coding accuracy for providers, staff and third-party support.

• Train and mentor other Encounter Documentation Audit staff, providing guidance and answering questions as needed.

• Oversight of Encounter Documentation Auditor's training of new providers

• Complete special projects as assigned by department leadership or Administration.

• Conduct particularly sensitive outside audit requests (Medicare, Medicaid and other insurers).

• Serve as backup staff member to other positions in Billing Compliance that have a single incumbent.

• Perform responsibilities of other Encounter Documentation Audit staff as needed.

• Engage with outside coding and consulting service vendors.

• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• High school diploma or GED is required; college degree is preferred.

Licenses/Certificates

• Must possess coding certificate if hired after 2024

Knowledge, Skills and Abilities

• Proficiency with the Clinic's practice management system, electronic health record and Microsoft Office suite.

• Must possess strong analytical and communication skills.

• Ability to work independently on assigned duties with minimal supervision.

• Ability and desire to further knowledge of laws/regulations/coding expertise by continuing education efforts (reading manuals, subscriptions, newsletters; attending in-services and education conferences)

Working Environment

• Some amount of travel to clinical locations, typically locally, is required.

• Requires sitting and standing for periods of time working in an office environment.

• Manual dexterity required for use of computer keyboard.

• This job operates in a professional office environment. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHI/Privacy Level

HIPAA1