Professional Coding Auditor-Educator

About the role

Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff.

Responsibilities

• Perform coding quality audits, provide ongoing feedback and education.
• Utilize various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment.
• Manage activities of designated coding personnel in training for WVU Healthcare and monitor their developmental activity.
• Manage quality improvement audits and training of designated coding staff.
• Act as expert coding resource to coders, clinical documentation improvement, providers and revenue cycle, as well as to specialty groups and meetings.
• Act as Super user for all Coding-related Electronic Medical Record Systems necessary for complete an accurate coding and EMR Data Governance.
• Update policies and procedures for those areas of responsibility, in-services appropriate staff regarding changes in these areas, develop and maintain coding related policies, procedures, query development, work queues and training materials in conjunction with management.
• Continually communicate with Coding Staff, Medical Staff, Physician Advisor, Department Chairman, and Department Administrators.
• Organize, facilitate, perform, track, trend, and report on internal quality reviews.
• Design and use audit tools (i.e ROC) to monitor the accuracy of coding, documentation gaps, and billing performed by Coding Specialists.
• Coordinate audits performed by outside agencies by obtaining accounts to be reviewed, acting as a liaison between agency and HIM personnel to gather data to be reviewed, facilitating exit conferences with Coding Specialists, and providing final reports to Coding Manager.
• Coordinate coding/documentation denial reviews and facilitate appeal letter formation.
• Communicate regularly with the Coding Leadership on activities, problems, coding and/or documentation issues and pending audits.
• Ensure audit (external and internal) recommendations are completed (i.e. coding education, coding changes, rebills).
• Extract and analyze from various sources then develop action plan when necessary.
• Aid in on-boarding of new Coding Specialists in regard to coding/quality related policies, audits and initiatives.
• Update Coding Specialists on compliance and other regulatory changes.
• Keep abreast of coding changes, state and federal regulations and coding resources (i.e. Coding Clinic).
• If needed, this position could be responsible for development and design of the curriculum for the WVU Healthcare Coding Certificate Program, as well as other special projects regarding the overall Data Governance of the EMR to enhance coding.
• Utilize all necessary systems as part of curriculum and educational courses and administer exams.
• Involvement with testing and installation of system upgrades when necessary to assure curriculum is up-to-date.

Qualifications

• Minimum Qualifications: Graduate of a Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR Graduate of a Medical Coding Certification Program AND Five (5) years of coding experience; OR High School Diploma or Equivalent AND Eight (8) years of coding experience. Certification in ONE of the following: Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) through American Health Information Management Association) Certified Outpatient Coder (COC) through American Academy of Professional Coders Certified Coding Specialist (CCS) through American Health Information Management Association Certified Professional Coder (CPC) through American Academy of Professional Coders.
• Preferred Qualifications: Bachelor’s degree in Health Information Management or related field. Experience Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, and MS-DRG, HCC and APR-DRG assignment for Positions and multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines” for Professional Coding Positions preferred. Previous supervisory or project management experience.