Outpatient Coding Auditor

Description

Responsible for implementing and maintaining a compliance plan for outpatient coding and reimbursement. The Outpatient Coding auditor will assist the Coding Manager with Outpatient and Emergency Coding Services, and the development of policies and procedures.

Develops education and Supervises programs

• regarding elements of the HIM Compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff, physicians, billing personnel and ancillary departments.
• Coordinates and conducts continual reviews, tracking and trending following the outpatient coding audits.
• Educates new outpatient coders on documentation requirements including how to read an outpatient medical record and extrapolate the required documentation with regards to outpatient surgery coding.
• Educates outpatient coders on ICD-10-CM guidelines, coding conventions and Coding Clinics pertinent to outpatient surgery coding.
• Educates outpatient coders on CPT/HCPCS guidelines, coding conventions and CPT Assistant pertinent to outpatient surgery coding.
• Educates outpatient coders with regards to pertinent coding policies and procedures.
• Conducts quality review of coding to assure accurate codes, APC assignment, and accurate reimbursement.
• Summaries quality monitoring results to support performance appraisals and process improvement activities.
• Researches and responds to outpatient coding questions.
• Works the daily unbilled report to ensure timely coding.
• Reviews quality audit results with individual associates and conducts follow-up reviews to assure resolution.
• Acts as liaison with the PFS department to resolve all outpatient coding review requests.

  Minimum Qualifications

  • Certified Coding Specialist (CCS) certification required.
  • Minimum 4 years' experience with coding ICD-10 in an acute care setting with 2 years of experience in performing APC coding audits.
  • Possesses knowledge of APC and grouping methodologies; in particular what diagnoses / procedures APC assignment.
  • Must have basic computer skills in word processing and spreadsheet utilization.
  • Must have excellent interpersonal skills to develop relationships necessary to facilitate and educate, and excellent prioritization and organizational skills.

    Physical Requirements

    • 20-50 lbs; 0-33% of the work day (occasionally)
    • 11-25 lbs, 34-66% of the workday (frequently)
    • 01-10 lbs, 67-100% of the workday (constantly)
    • Lifting 50 lbs max
    • Carrying of objects up to 25 lbs
    • Occasional to frequent standing & walking
    • Occasional sitting
    • Close eye work (computers, typing, reading, writing)

    Environmental Factors

    • Factors affecting environment conditions may vary depending on the assigned work area and work tasks.
    • Environmental exposures include, but are not limited to:
    • Blood-borne pathogen exposure
    • Bio-hazardous waste
    • Chemicals/gases/fumes/vapors
    • Communicable diseases
    • Electrical shock
    • Fluorescent lighting
    • Indoor/Outdoor conditions
    • Latex
    • Lighting
    • Patient care/handling injuries
    • Radiation
    • Shift work
    • Travel may be required.
    • Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

    Additional Details

    Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org . Please note that one week's advance notice is preferred.