• Assist with performing and documenting scoping of the IT SOX program. • Provide guidance around IT processes, risks, and controls - both for IT general controls and IT-dependent business process controls such as application controls and report-reliant controls. • Collaborate with distributed IT teams (Corporate IT, Finance IT, Engineering) to advise on IT risk management and the ongoing evaluation and update of IT policies, procedures, SOPs, flowcharts, data flow diagrams, and narratives. • Coordinate the execution of internal audits and the needs of internal and external auditors, including planning and coordinating walkthroughs, and testing of IT general controls, application controls, and key system-generated reports. This includes a review of internal audit testing work papers. • Evaluate and ensure remediation of identified control deficiencies in a timely manner. • Track audit issues, initiate follow-up actions, and provide control advice to management to ensure that appropriate action is taken on all recommendations. • Monitor for emerging risks and help project manage control design for new products, processes, system implementation, or emerging areas identified by the Internal Audit risk assessment, and work with process owners and projects teams to ensure appropriate internal controls are in place prior to launch. • Assist in the preparation of executive presentations and participate in recurring SOX meetings.

• Conduct coding audits of outpatient facility services, including ancillary procedures, PET scans, and simple visit encounters, to ensure coding accuracy and regulatory compliance. • Perform comprehensive audits and reviews of professional Evaluation and Management (E/M) documentation and coding to validate code assignment and reimbursement accuracy. • Provide ongoing feedback, education, and coaching to coding staff to improve coding quality, consistency, and adherence to coding guidelines. • Review and analyze clinical documentation and assigned codes from a variety of medical records to ensure accurate ICD-10-CM, CPT, and other applicable code assignment in accordance with current coding standards, regulatory requirements, and client-specific policies and guidelines.

• Independently audit clinical documentation to ensure consistent with billed services in a production environment • Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered • Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care. • Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly • Share ideas that offer process improvements and share with team for education.

Role Description Under the direction of the Sr. Manager of PCN Coding Integrity, the Coding Quality Educator will assist with the day-to-day operations of the PCN Coding Integrity Team and regional coding teams. This position will assist with: - New employee training and ongoing department education - Identification, development, and delivery of new and ongoing provider education and training related to coding and clinical documentation - Conducting independent and collaborative provider coding reviews according to the coding integrity work plan - Developing appropriate documentation to support coding review work performed Qualifications - Bachelor’s Degree in Management, Health Information Technology, or related field or an equivalent combination of education and experience - Upon hire: National Certification from American Academy of Professional Coders, or - Upon hire: National Certification from American Health Information Management Association - 4 years professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work; 5 years preferred - 4 years experience conducting medical coding provider audits and quality performance measures; preparing audit reports with recommendations; and providing provider education and feedback to facilitate improvement in documentation and coding; 5 years preferred - Strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment Requirements - Associate's Degree in a Healthcare related field (preferred) - 5 years experience in coding for multispecialty practice (preferred) - 2 years experience in professional fee billing methodologies (preferred) - Experience with IDX, Allscripts, Advanced Web, Meditech (preferred) - Experience with project management (preferred) Benefits - Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching - Health care benefits (medical, dental, vision) - Life insurance and disability insurance - Time off benefits (paid parental leave, vacations, holidays, health issues) - Voluntary benefits and well-being resources