CodingAuditor

_The Facility Audit Department at BCBST is searching for a talented Coding Auditor to join our dynamic team in performing detailed claims payment quality reviews and coding compliance audits. This role is essential in reviewing hospital claims to ensure appropriate reimbursement, as well as compliance with contracts, regulatory requirements, and BCBST guidelines. A unique aspect of this position is providing educational feedback and reports to TN facilities based on audit findings. While travel is not currently required, there may be rare occasions when traveling to a TN facility for an audit becomes necessary, so we’re seeking candidates who reside in Tennessee or contiguous counties._ __ _The ideal candidate will bring a Bachelor’s degree or equivalent experience, together with at least two years of facility inpatient or outpatient coding and auditing experience, or reimbursement experience in a payer environment. An active AHIMA certification is required, or the willingness to obtain CCS within a year of hire. Experience with Facets, Care Advance, and other internal systems is highly valued. We are especially excited to find someone eager to use Enterprise-AI approved tools in their work, helping us uncover opportunities for improvement and drive greater efficiencies. _ **Job Responsibilities** * Communicating audit results to appropriate parties; recommending corrective course of action. * Reviewing the claims materials and medical record information submitted and assessing accuracy of provider submitted claims. * Planning and conducting investigations for certain claims; identifying potential subrogation or fraud and engaging special investigate unit as needed. * Documenting audit results and supporting the development of audit policies and procedures. **Job Qualifications** _Education_ * Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment. _Experience_