Provider Services Auditor

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and Coding Compliance Program for professional services billed by providers employed with St. Luke's Physician Group (SLPG). In doing so, works with providers and their office staff, as well as the Coding and SLPG Billing Department.

JOB DUTIES AND RESPONSIBILITIES

Perform quality audits to include reviewing medical record documentation for completeness and accuracy to support billed claims. Generate provider reports through billing software. Coordinates, schedules, and meet with providers to perform education for the professional service documentation and coding audits of both office and in-patient medical records. Maintain and record audits in Excel spreadsheet format and through an auditing software program. Is a resource to the coding department, SLPG practices, providers, and billing department. Assisting with the development of training materials for compliance education and training modules. Provides training classes to new providers throughout the year along with providing education to the Residency programs. Maintain current knowledge of coding and documentation educational updates for primary care and specialty services. Assists in the formulation and review of Network policies and guidelines affecting the coding of professional services. Assists in maintaining the FY audit plan and accurate accounting of time allocated to each audited provider. Analyzing data in Excel or other software programs and making sound recommendations based on the results.

PHYSICAL AND SENSORY REQUIREMENTS

Sitting for up to eight hours per day. Driving distances up to 50 miles one way. Must possess hearing, seeing, speaking and reasoning senses necessary to carry out job duties. Occasional lifting/carrying of objects such as office supplies, files, etc. with maximum of ten pounds. Walking, bending, twisting and reaching necessary to carry out duties of job.

EDUCATION AND TRAINING

High school diploma or equivalent required. Certification of CPC, CCS, or CCS-P highly desired OR Coding certification within one year. Working knowledge of ICD-9, CPT, and HCPCS coding required.

TRAINING AND EXPERIENCE

At least 2 years of healthcare experience with background and competency in coding and documentation State and Federal regulatory requirements including Medicare, Medicaid and third-party payers as well as strong written/verbal communications skills preferred. Strong computing and data management abilities, analytical, and interpersonal and communication skills which are all essential skills. Microsoft office skills to include word, Excel and Power Point Presentations Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Founded in 1872, St. Luke's University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue in excess of $4 billion, the Network's service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke's hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke's Children's Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare's five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World's Best Hospital. The Network's flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING

HOSPITAL IN THE COUNTRY.

In 2021, St. Luke's was identified as one of the 15 Top Health Systems nationally. St. Luke's is the ONLY health care institution in the Lehigh Valley to be named a Top Workplace regionally repeating the exclusive honor for the third year in a row. Also, for the third straight year, St. Luke's has been a Top Workplaces in the Philadelphia Region by the Philadelphia Inquirer, ranking 9th in the large employer category for 2025 and the only health care system in PA to receive this award. In 2025, St. Luke's was recognized as a national Top Workplaces by USA Today, three years in a row, including the 3rd best health care system in the nation in 2023 and 2024. Lastly, in 2025, St. Luke's was named a Top Workplace in New Jersey for the third year in a row. Learn More Here.