Auditing & Education Specialist - IP/OP Facility

About the Role

Serves in a consulting role by evaluating the work of client’s coders in their assignment of ICD-10, CPT and/or HCPCS codes to hospital inpatient, outpatient and/or physician practice encounters. Performs concurrent or retrospective reviews to inventory code assignments and report the data to the client. Develops and delivers educational content to clients related to audit findings. Must have extensive IP facility and/or OPP facility coding and auditing experience. Must have AHIMA or AAPC certification - CCS, RHIT, RHIA strongly preferred, will consider CIC or COC. This is a remote position.

Essential Duties and Responsibilities

• Perform complex concurrent and/or retrospective analysis of inpatient medical record documentation to validate coded data in accordance with AHA, CMS, AHIMA, Coding Clinic, and official ICD-10 guidelines.
• Analyze findings and identify potential root causes of produced errors.
• Prepare summary reports of findings to clients, supplying specific references supporting findings contained within the provided audit report.
• Provides second-level review of processes to ensure compliance with legal and procedural policies and to ensure appropriate code assignments.
• Research, analyze, and respond to inquiries regarding compliance, coding, and denials.
• In all situations, protect the privacy and confidentiality of patient health and client information, and follow the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines and compliance practices, standards, and procedures.
• Functions as a member of the Consulting Services Team which develop and provide coding education to clients.
• Conduct Audits as assigned meeting the productivity standards as set by record type for each audit. The threshold for billable productive hours, when client work is available, is expected to be at or above 80%.
• Prepare deliverables for the client as required for the audit scope while meeting timelines.
• Conduct independent QA of their assigned audit results prior to final submission for QA review and approval. The minimum accuracy expectation is 95%.
• Report work time and work products in a timely and accurate manner.
• Communicates with coworkers in an open and respectful manner that promotes teamwork and knowledge sharing.
• Interact with clients in a professional manner that, always, exhibits excellent relationships, work performance and communication skills so as to support the company and its business interests.
• Provide schedule of planned work activities, events and sites, and any changes to same, to Management and appropriate staff.
• Maintenance of professional credentials and knowledge of coding, reimbursement, and compliance issues through continuing education.
• Periodic travel, as applicable.
• Other duties and responsibilities, as assigned.

Knowledge, Skills & Abilities

• Recognized credential from AHIMA or AAPC.
• Experience with telecommuting and electronic medical record systems required.
• Strong analytical skills.
• Proficient computer skills, specifically Microsoft Office products.
• Strong team player.
• Ability to work with multiple and diverse clients and projects.
• Ability to work with minimal supervision.
• Ability to maintain and access multiple files.
• Assure that work product is completed with high levels of accuracy and attention to detail.
• 5+ years’ experience coding and/or auditing in an acute care facility or clinic, of patient types listed in the Job Summary of this document, or other relevant experience.

Physical Demands

Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.