Coding Auditor & Education Advisor

JOB SUMMARY:

Audits medical record documentation and coding to extract data and determine appropriate ICD-10-CM/PCS and HCPCS codes for billing, internal and external reporting, and compliance with the Official Coding Guidelines for Coding and Reporting, payer regulations, and hospital policy. Educates physicians and clinical personnel to ensure complete documentation in the medical record and queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices. Educates and trains coders to ensure both a working knowledge of coding and reimbursement guidelines and successful career ladder completion, including the development of training materials and reference documents. Researches audit results, error reports, and denials and resolves by successful appeal, staff education, and correction of discrepancies.

GENERAL REQUIREMENTS:

• Adheres to the hospital and departmental attendance and punctuality guidelines
• Performs all job responsibilities in alignment with the core values, mission and vision of the organization
• Performs other duties as required and completes all job functions as per departmental policies and procedures
• Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs)
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.

WORKING CONDITIONS:

• General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
• May be required to change from one task to another of different nature without loss of efficiency or composure.
• Periods of high stress and fluctuating workloads may occur.
• May be scheduled as needed including overtime

EDUCATION REQUIREMENTS:

• 4 year / Bachelor's Degree in Health Information Management or related medical degree (Required) ;In lieu of a Bachelor's Degree; an Associate Degree and a Minimum of 4 years additional relevant experience is acceptable.

EXPERIENCE REQUIREMENTS:

• 4 - 5 years Experience with ICD-9, ICD-10, and HCPCS coding including hospital inpatient medical records (Required

• 4 - 5 years Extensive knowledge of medical terminology, pathophysiology, and pharmacology (Required)

• 4 - 5 years Experience calculating and analyzing MS-DRG, DRG, APC, and other payer reimbursement methodologies (Required)

CERTIFICATIONS AND LICENSURES:

• Required Certifications/Licensures: Certified Coding Specialist (CCS)

• Preferred Certifications/Licensures: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), AHIMA Approved ICD-10 Trainer

GENERAL SKILLS:

• Organizational Skills

• Communication Skills

• Interpersonal Skills

• Customer Relations

• Mathematical

• Analytical

• Grammar / Spelling
• Read / Comprehend Written Instructions

• Follow Verbal Instructions

• Basic Computer Skills

• Microsoft Office Suite

• General Clerical Skills

PHYSICAL REQUIREMENTS:

• Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors
• Ability to perform - repetitive tasks/motion

PHYSICAL DEMANDS:

• Standing - Occasionally within shift (1-33%)

• Walking - Occasionally within shift (1-33%)

• Sitting - Continuously within shift (67-100%)

• Bending/Stooping - Occasionally within shift (1-33%)

• Twist at waist - Occasionally within shift (1-33%)

• Pushing/Pulling - Occasionally within shift (1-33%)

• Reaching above shoulder - Occasionally within shift (1-33%)