Coding Educator-Auditor

JOB SUMMARY/PURPOSE

Provides formal and informal coding and regulatory education/training to Providers and Professional Coders. The education will include coding and documentation requirements as directed by Federal and State requirements as well as the AMA. Serves as a liaison between providers and coders. Responsible for reviewing (auditing) professional charges, medical records, and claims to ensure accuracy and compliance with the CMS guidelines as well as CPT, HCPCS, ICD-10 coding guidelines. Identifies errors, inconsistencies, and areas for improvement in coding and documentation with current guidelines and regulations. Compiles and presents reports of audit results, highlighting areas for improvement, educating, and reauditing. Answers coding questions for clinic managers, providers, and other staff.

DEPARTMENT DESCRIPTION

The Regional Business Office Physician Coding Team is responsible for the accurate and timely coding of the Samaritan Health Services clinic providers according to all applicable guidelines with applicable federal/state rules and regulations.

EXPERIENCE/EDUCATION/QUALIFICATIONS

• High school diploma or equivalent required.
• Two (2) certifications (CPC, CRC Risk adjuster, CPMA, CPCO compliance officer, or RHIT) required upon hire.
• Three (3) years experience in CPT EM leveling, ICD-10 diagnosis coding, HCC diagnosis coding, medical claims auditing, and provider education required.
• Experience with data analysis and report preparation required.

KNOWLEDGE/SKILLS/ABILITIES

• Strong knowledge of healthcare regulations and standards, including Medicare and Medicaid. Knowledge of coding and billing practices in healthcare.
• Strong problem-solving and critical thinking skills.
• Excellent attention to detail and ability to identify errors and discrepancies.
• Excellent verbal and written communication skills.
• Ability to work independently and as part of a team.
• Ability to work well under pressure and meet tight deadlines.
• Proficiency in Microsoft Office and other relevant software applications.

PHYSICAL DEMANDS

• Rarely (1 - 10% of the time)
• Occasionally (11 - 33% of the time)
• Frequently (34 - 66% of the time)
• Continually (67 – 100% of the time)
• CLIMB - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
• LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
• LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
• CARRY 1-handed, 0 - 20 pounds
• BEND FORWARD at waist
• KNEEL (on knees)
• STAND WALK - LEVEL SURFACE
• ROTATE TRUNK
• SIT
• CARRY 2-handed, 0 - 20 pounds
• ROTATE TRUNK Sitting
• REACH - Upward
• PUSH (0-20 pounds force)
• PULL (0-20 pounds force)