Auditor/Educator I:
Carolinas HealthCare System

Carolinas HealthCare System
Wilmington North Carolina

Job Req ID: 155187

Position Number: 00162676

Employment Type: Full Time

Shift: Variable/On Call

Shift Details: Monday - Friday, 8:00am - 5:00pm

Standard Hours: 40.00

Department Name: CHSMG Coding Support

Location: Physician Services Group

Location Details:  Wilmington




Job Summary
Provides coding, billing and compliance support and assists with training for physicians, mid levels, residents, support staff and administration of the CHS Physicians Services Group and/or regional network providers; verifies that activities performed by providers/practices are in compliance with applicable federal and state statutes/regulations and helps identify ways to address preventable revenue loss.

Essential Functions
  • Maintains a working knowledge of the ICD-9-CM, ICD-10-CM and CPT/HCPCS coding principles and the AMA/CMS Documentation Guidelines (DGs); keeps current on any changes to payer-specific reimbursement policies; acts as a coding resource to their assigned practices and the CBO, responding to inquiries on a timely basis.
  • Conducts medical record reviews to evaluate appropriateness of diagnosis, procedure and Evaluation and Management (E/M) codes assigned; documents review findings; provides written reports to leadership as directed; provides follow-up education based on review findings.
  • Reviews and analyzes denial information from third party payers to understand reasons for denials; coordinates with practice management and the CBO to address operational issues that are contributing to the denials; reviews denials received from the RAC (Recovery Audit Contractor) as needed.
  • Assists with the analysis of E/M coding profiles and other comparative data to identify utilization trends and coding patterns that may indicate where to focus further analysis and education.
  • Reviews encounter form information at least annually; recommends additions, revisions and deletions to codes and encounter form layout as indicated; coordinates the timing of these reviews to correspond with the ICD-9-CM, ICD-10-CM and CPT/HCPCS code changes that are published each October and January.
  • Assists in the development of tools such as Job Aids, Documentation Templates, etc., that will aid providers, practice management and office staff help ensure compliance in capturing identified revenue.
  • Assists in the development and delivery of one-on-one and group education/training classes.
  • Alerts Corporate Compliance management to business practices and processes that call for investigation and/or intervention.
  • Maintains a working knowledge of the IDX billing system and TES functionality.
  • Establishes and maintains a positive and professional working relationship with physicians, clinical, administrative and other related staff.
  • Assists with research on difficult claims and unusual billing situations.
Physical Requirements
Ability to sit and concentrate for extended periods of time. Frequent reaching and handling of reports and/or medical records. Local travel to assigned practices required. Ability to work under pressure and meet deadlines.

Educational Experience
High school diploma or equivalent required. CPC, CCS-P, RHIT or RHIA credential required. Knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding classification systems required. Minimum of 3 years coding experience for multiple specialties including but not limited to Family Medicine, Internal Medicine, Pediatrics and OB/Gyn. Knowledge of medical terminology and anatomy and physiology required. Prior IDX billing system experience preferred.


At Carolinas HealthCare System, our patients, communities and teammates are at the center of everything we do. Our commitment to diversity and inclusion allows us to deliver care that is superior in quality and compassion across our network of more than 900 care locations.


As a leading, innovative health system, we promote an environment where differences are valued and integrated into our workforce. Our culture of inclusion and cultural competence allows us to achieve our goals and deliver the best possible experience to patients and the communities we serve.


Posting Notes: Not Applicable

Carolinas HealthCare System is an EOE/AA Employer

Basic Qualifications