Coding Auditor/Educator
- Recruiter
- Childrens Hospital of The Kings Daughters
- Location
- Norfolk, Virginia, United States
- Salary
- Competitive salary
- Posted
- 27 Oct 2020
- Closes
- 28 Oct 2020
- Ref
- 13561
- Job role
- Audit
- Sector
- Healthcare
General Summary:
The Coding Auditor/Educator will function as both an auditor and an educator and is responsible for providing oversight, leadership, training, education and support to the providers, hospital, coding staff and denial team aspects of facility coding and documentation as it applies to the hospital/facility setting.
Essential Duties and Responsibilities:
• Plans, directs and monitors the retrospective coding-related denials program for all payers across the hospital/facility setting.
• Process all government and commercial retrospective audit requests, denials, and appeals.
• Corrects assignment of ICD-CM/PCS, and CPT codes and clinician documentation to ensure that medical records meet all federal/state mandatory regulatory guidelines as well as internal controls.
• Prepares appeal letters and identifies appropriate documentation and references when appropriate. Trends and reports the retrospective denial requests, assuring that all timelines are met.
• Prepares and conducts training seminars and presentations on applicable topics. Provides education, as needed, for new or existing staff, coders, physicians, and other health care professionals.
• Utilizes software applications and electronic coding references to perform coding related tasks.
• Assists Coding and CDI leadership in the development of policies and controls for appropriate support.
• Collaborates with vendors and external auditors for analyzing quality. Submits data to vendors and delivers timely feedback and education to coders regarding findings for improvement.
• Performs other duties as assigned by leadership.
Minimum Education and Experience Requirements:
• Associates degree in health information management, business, or other relate field, OR three years coding and auditing experience working with hospitals in operations, compliance, clinical or finance areas.
• In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, DRG prospective payment systems; APR-DRG, MS-DRG and EAPG prospective payment systems a plus.
• Considerable experience and knowledge in federal, state and commercial billing, compliance and reimbursement regulations and areas of scrutiny for potential fraud and abuse.
• Thorough knowledge of billing, reimbursement, anatomy, physiology, disease processes, medical terminology, ICD-CM/PCS and CPT coding system, DRGs, APCs, LCDs/NCDs, MACs/FIs, and RACs required.
• Must demonstrate and apply advanced knowledge of Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant
• General knowledge of hospital information systems, encoder and data abstracting software, Microsoft Office, including Access, Excel, Word, and PowerPoint.
• Knowledge of CMS, DNV-GL requirements, HIPAA and federal/state guidelines as applicable.
• Extensive critical and analytical thinking skills required with ability to organize and coordinate multiple functions and tasks.
• Highly developed leadership skills, interpersonal skills and the ability to work collaboratively in a matrix model. Ability to effectively communicate and articulate outcomes from data analysis individually or in a group setting including, but not limited to, providers, management and hospital leadership.
• Ability to work independently and meet deadlines. Motivate, train and teach individuals; demonstrate skills in interpersonal relationships with honesty, integrity and in oral and written communication.
• Willingness to evaluate current processes, offer suggestions for improvement and adapt to change.
• Must pass a coding proficiency pre-hire test with 95% accuracy or higher.
Licenses and/or Certifications:
Minimum credential in one or more:
Certified Coding Specialist (CCS); Registered Health Information Administrator (RHIA); Registered Health Information Technician (RHIT); Certified Coding Specialist-Physician (CCS-P) at time of hire/transfer, Certified Professional Coder (CPC), Certified Outpatient Coder (COC); must maintain registration/certification status of the above.
The Coding Auditor/Educator will function as both an auditor and an educator and is responsible for providing oversight, leadership, training, education and support to the providers, hospital, coding staff and denial team aspects of facility coding and documentation as it applies to the hospital/facility setting.
Essential Duties and Responsibilities:
• Plans, directs and monitors the retrospective coding-related denials program for all payers across the hospital/facility setting.
• Process all government and commercial retrospective audit requests, denials, and appeals.
• Corrects assignment of ICD-CM/PCS, and CPT codes and clinician documentation to ensure that medical records meet all federal/state mandatory regulatory guidelines as well as internal controls.
• Prepares appeal letters and identifies appropriate documentation and references when appropriate. Trends and reports the retrospective denial requests, assuring that all timelines are met.
• Prepares and conducts training seminars and presentations on applicable topics. Provides education, as needed, for new or existing staff, coders, physicians, and other health care professionals.
• Utilizes software applications and electronic coding references to perform coding related tasks.
• Assists Coding and CDI leadership in the development of policies and controls for appropriate support.
• Collaborates with vendors and external auditors for analyzing quality. Submits data to vendors and delivers timely feedback and education to coders regarding findings for improvement.
• Performs other duties as assigned by leadership.
Minimum Education and Experience Requirements:
• Associates degree in health information management, business, or other relate field, OR three years coding and auditing experience working with hospitals in operations, compliance, clinical or finance areas.
• In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, DRG prospective payment systems; APR-DRG, MS-DRG and EAPG prospective payment systems a plus.
• Considerable experience and knowledge in federal, state and commercial billing, compliance and reimbursement regulations and areas of scrutiny for potential fraud and abuse.
• Thorough knowledge of billing, reimbursement, anatomy, physiology, disease processes, medical terminology, ICD-CM/PCS and CPT coding system, DRGs, APCs, LCDs/NCDs, MACs/FIs, and RACs required.
• Must demonstrate and apply advanced knowledge of Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant
• General knowledge of hospital information systems, encoder and data abstracting software, Microsoft Office, including Access, Excel, Word, and PowerPoint.
• Knowledge of CMS, DNV-GL requirements, HIPAA and federal/state guidelines as applicable.
• Extensive critical and analytical thinking skills required with ability to organize and coordinate multiple functions and tasks.
• Highly developed leadership skills, interpersonal skills and the ability to work collaboratively in a matrix model. Ability to effectively communicate and articulate outcomes from data analysis individually or in a group setting including, but not limited to, providers, management and hospital leadership.
• Ability to work independently and meet deadlines. Motivate, train and teach individuals; demonstrate skills in interpersonal relationships with honesty, integrity and in oral and written communication.
• Willingness to evaluate current processes, offer suggestions for improvement and adapt to change.
• Must pass a coding proficiency pre-hire test with 95% accuracy or higher.
Licenses and/or Certifications:
Minimum credential in one or more:
Certified Coding Specialist (CCS); Registered Health Information Administrator (RHIA); Registered Health Information Technician (RHIT); Certified Coding Specialist-Physician (CCS-P) at time of hire/transfer, Certified Professional Coder (CPC), Certified Outpatient Coder (COC); must maintain registration/certification status of the above.