Role Description Wilson Elser is currently seeking a Legal Auditor to join a national team supporting Quality Assurance and Client Audit Services. In this role, you will review active files to capture key data points and address issues related to file handling. This position would be ideal for an experienced litigator who wants to phase out of an active practice. - Review files on our cloud based document management and time entry systems - Ability to capture data accurately - Ability to evaluate file handling, identifying both exceptional efforts and opportunities for improvement - Clear concise writing skills - Engage in calibration exercises Qualifications - J.D. from an accredited law school - 5+ years of litigation experience - Insurance defense preferred but not required - Auditing experience at an insurance carrier is a plus - Current license not required (but license must have been in good standing at the time license lapsed) - Self-starter with acute attention to detail is required - Comfortable working both independently and collaboratively - Strong analytical and communication skills both oral and written - Ability to exercise professionalism, integrity, and discretion with confidential and sensitive information is required - Experience with Electronically Stored Information and document management systems, including computer-assisted review technologies, is a plus Requirements - A variety of factors are considered in making compensation decisions, including but not limited to experience, education, licensure and/or certifications, geographic location, market demands, other business and organizational needs, and other factors permitted by law. - Final salary wages offered may be outside of this range based on other reasons and individual circumstances. - This position is considered full-time and therefore qualifies for benefits including 401(k) retirement savings plan, medical, dental, vision, disability, and life insurance. - Details of participation in these benefit plans will be provided if an employee receives an offer of employment. Benefits - Outstanding benefits package, including 401k match and generous PTO plan - Ample opportunities for professional development and advancement - Access to corporate discount plans and other benefits

• Analyze client invoice data and pinpoint vendor overbillings or under billings. • Apply general audit principles such as pattern recognition, data filtering, and cross-referencing multiple data sources. • Analyze contracts, applicable tariffs, Interconnection Agreements, and research other sources of potential data. • Load potential overbillings or under billings in a spreadsheet format into TEOCO’s web-based Claim Center application. • Analyze any responses from vendors and provide ongoing support to the reconciliation team.

• Validates accuracy of assigned ICD-10-CM and PCS codes and DRG grouping • Validates accuracy of assigned HCPCS, CPT-4 and APC grouping secondary diagnoses and procedures. • Validates the assignment of medically necessity narrative diagnoses as required for specific inpatient medical coverage policies including communication with clinical and/or physician. • Assesses the use and quality of coding queries; reports non-compliance with regulatory and/or department standards. • Monitors coder trends and patterns for education opportunities and/or physician and clinical documentation improvement needs. • Maintains DRG change accuracy of 95%. • Supports CCDI department as Coding Reimbursement & Audit team as Subject Matter Experts (SME) in ICD-10-CM and PCS reporting. • Utilizes departmental audit databases and/or software accurately to ensure audit data is robust and accurate to relay coded data accuracy • Prepares detailed reports by use of excel, excel pivot tables and/or other software as provided; continuously improves on trend identification and capture for optimal reporting • Provides ad hoc and/or additional data to support identification and feedback of opportunities to leadership • Identifies and reports opportunities for process improvement • Captures meeting minutes, follow ups and action plans as required according to audit scope. • Recommends refinement and implementation of methods and procedures used to for coder and physician education and training; creates and shares tips and audit team education to support department collaboration and efficiency • Provides adequate data to facilitate the identification of development of actions • Updates and develops team policies and procedures to optimize processes; recommends practices to maintain standards for correct coding • Consistently meets team KPI goals to support department and system revenue and quality targets. • Responds to changes in workload/volumes with team and/or lead communicates when to ensure coverage adjusts for optimal coverage volumes • Verifies, researches and/or and review codes, charges and reimbursement on patient accounts and denials or for service lines. • Completes productivity tracking daily; responds and initiates Analyst to Analyst discussions to team ensure decisions are collaborative, consistent and accurate. • Resolves ITS issues impacting work by collaborative communication with team, vendor, informaticist and/or IT as required. • Maintains frequent and regular contact with manager and seeks consultation and guidance when appropriate. • Participates in personal annual performance evaluation, providing opportunity for growth and development. • Participates in committee work and cross functional teams as determined by department leadership • Consistently abides by the Standards of Ethical Coding as set by AHIMA and adheres to Official Coding Guidelines; reviews and applies the directives published in the AHA Coding Clinic and CPT Assistant publication and other approved resources. • Maintains certification with CE credits. Pursues knowledge and participation in HFMA, AAPC and AHIMA organizations. • Maintains knowledge of regulatory requirements, payer coverage determinations; demonstrates initiative in identifying areas requiring further research. • Completes of all department and system hospital required training and education according to schedule; maintains all required certification(s) and continuing education requirements. • Meets audit, project and task deadlines. • Serves as a subject matter expert in expert in areas of documentation, ICD-10-CM and PCS coding with proficiency in CPT-4, HCPCS and modifier assignment.

• Perform multiple audit engagements and lifecycles at one time • Overseeing the entire audit process including compiling data cedants or TPAs on claims handling structure and requesting information in preparation for the audit • Audit Cedants, TPAs and Client Claims Teams to ensure adherence to contractual agreements, SLAs and within industry standards and regulatory requirements • Review pre audit questionnaire (PAQ) responses and necessary documentation; drafting follow-up questions and inquiries as needed • Review direct and/or ceded claims submissions for accuracy, timeliness, and compliance with reinsurance contract terms (treaty and facultative, where applicable) • Manage communication, preparatory, onsite/remote, wrap up, meeting, and post audit/reporting activities • Analyze claims handling practices through structured audit testing and sampling to identify systemic risks, deviations from contract terms, and exposure trends • Evaluate any liability or coverage decisions to evidence appropriate claims handling decisions • Prepare clear, defensible audit reports and executive summaries; support client read ‑ outs and respond to follow ‑ up inquiries regarding findings and recommendations • Liaise with Audit Administrator regarding audit preparations and reinsured/TPA readiness