Coding Auditor/Educator
- Full-Time
- Morgantown, WV
- West Virginia University Hospital
- Posted 3 years ago – Accepting applications
Job Description
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.
Responsible
for the overall auditing and education plans for the Coding staff. The
Coding Auditor / Educator perform coding quality audits, provide ongoing
feedback and education. The Coding Auditor / Educator utilizes 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.
MINIMUM QUALIFICATIONS:
EDUCATION,
CERTIFICATION, EXPERIENCE, AND/OR LICENSURE:
1.
Graduate
of Health Information Technology (HIT) or equivalent program AND Five (5)
years of coding experience;
OR Medical Coding Certification Program AND
Five (5) years of coding experience;
OR High School Diploma or Equivalent AND Eight (8) years
of coding experience.
2.
Certification
in one of the following: RHIT (Registered Health Information
Technician), RHIA (Registered Health Information Administrator), COC
(Certified Outpatient Coder), CCS (Certified Coding Specialist), or CPC
(Certified Procedural Coder).
PREFERRED QUALIFICATIONS:
EDUCATION,
CERTIFICATION, AND/OR LICENSURE:
1.
Bachelors
degree in Health Information Management or related field.
EXPERIENCE:
1.
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.
2.
Previous
supervisory or project management experience.
CORE
DUTIES AND RESPONSIBILITIES: The
statements described here are intended to describe the general nature of work
being performed by people assigned to this position. They are not intended
to be constructed as an all-inclusive list of all responsibilities and
duties. Other duties may be assigned.
1.
Manages
activities of designated coding personnel in training for WVU Healthcare and
assures the monitoring and reporting of respective employees developmental
activity.
2.
Manages
quality improvement audits and training of designated coding staff.
3.
Acts
as expert coding resource not only to coders, clinical documentation
improvement, providers and revenue cycle, but also to specialty groups and
meetings.
4.
Acts as Super
user for all Coding-related Electronic Medical Record Systems necessary for
complete an accurate coding and EMR Data Governance. Updates policies and
procedures for those areas of responsibility. In-services appropriate staff
regarding changes in these areas.
5.
Develops
and maintains coding related policies, procedures, query development, work
queues and training materials in conjunction with management.
7.
Continually
communicates with Coding Staff, Medical Staff, Physician Advisor, Department
Chairman, and Department Administrators.
8.
Organizes,
facilitates, performs, tracks, trends, and reports on internal quality
reviews.
9.
Designs and
uses audit tools (i.e ROC) to monitor the accuracy of coding, documentation
gaps, and billing performed by Coding Specialists.
10.
Coordinates
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. (Includes, but not limited to, HIA quarterly
audits, ROC Compass audits, etc.)
11.
Coordinates
coding/documentation denial reviews and facilitates appeal letter formation. Includes,
but not limited to, RAC denials, insurance/3rd party payor denials,
etc.
12.
Communicates
regularly with the Coding Leadership on activities, problems, coding and/or
documentation issues and pending audits.
13.
Ensures audit
(external and internal) recommendations are completed (i.e. coding education,
coding changes, rebills).
14.
Extracts and analyzes from various
sources then develops action plan when necessary.
15.
Assist with
on-boarding of new Coding Specialists in regard to coding/quality related
policies, audits and initiatives.
16.
Updates Coding
Specialists on compliance and other regulatory changes.
17.
Keeps abreast
of coding changes, state and federal regulations and coding resources (i.e.
Coding Clinic)
18.
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. Utilizes all necessary systems as part of curriculum and educational
courses and administers exams. Involvement with testing and installation of
system upgrades when necessary to assure curriculum is up-to-date.
PHYSICAL
REQUIREMENTS: The
physical demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
1.
Must be able to sit for long periods
of time.
2.
Must have visual and hearing acuity
within the normal range.
3.
Must have manual dexterity needed to
operate computer and office equipment.
4.
Must be Able to lift, push or pull
10-20 pounds.
WORKING
ENVIRONMENT: The work
environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
1.
Standard office environment.
2.
Visual strain may be encountered in
viewing computer screens, spreadsheets, and other written material.
3.
May require travel.
KNOWLEDGE,
SKILLS AND ABILITIES:
1.
Must possess excellent written and
verbal communication skills, as well as interpersonal skills necessary to
communicate effectively.
2.
Must possess the knowledge of related
provider healthcare compliance, revenue cycle operations, and auditing
techniques required.
3.
Must
possess the ability to mentor, educate and train others.
4.
Must
ensure quality and productivity standards.
5.
Must
be able to handle high stress and critical situations in a calm and
professional manner
6.
Must be able to concentrate and
maintain accuracy during constant interruptions.
7.
Must possess independent
decision-making ability.
8.
Must
possess the ability to prioritize job duties.
9
Must
be able to adapt to changes in the workplace and work assignments.
10.
Must
possess organizational and time management skills.
11
Must
possess the knowledge of anatomy, physiology and medical terminology.
12.
Must
possess analytical and problem solving skills.
13.
Must
be proficient in office software programs, including medical record and
billing systems.
14.
Must
possess the ability to analyze complex data and reports.
Date
Reviewed/Revised: December 2019
Apply to this Job
WVU Healthcare Coding Staff as directed by Coding Managers. Will also
oversee or perform the overall auditing and education plans for the Coding
staff.
Responsible
for the overall auditing and education plans for the Coding staff. The
Coding Auditor / Educator perform coding quality audits, provide ongoing
feedback and education. The Coding Auditor / Educator utilizes 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.
MINIMUM QUALIFICATIONS:
EDUCATION,
CERTIFICATION, EXPERIENCE, AND/OR LICENSURE:
1.
Graduate
of Health Information Technology (HIT) or equivalent program AND Five (5)
years of coding experience;
OR Medical Coding Certification Program AND
Five (5) years of coding experience;
OR High School Diploma or Equivalent AND Eight (8) years
of coding experience.
2.
Certification
in one of the following: RHIT (Registered Health Information
Technician), RHIA (Registered Health Information Administrator), COC
(Certified Outpatient Coder), CCS (Certified Coding Specialist), or CPC
(Certified Procedural Coder).
PREFERRED QUALIFICATIONS:
EDUCATION,
CERTIFICATION, AND/OR LICENSURE:
1.
Bachelors
degree in Health Information Management or related field.
EXPERIENCE:
1.
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.
2.
Previous
supervisory or project management experience.
CORE
DUTIES AND RESPONSIBILITIES: The
statements described here are intended to describe the general nature of work
being performed by people assigned to this position. They are not intended
to be constructed as an all-inclusive list of all responsibilities and
duties. Other duties may be assigned.
1.
Manages
activities of designated coding personnel in training for WVU Healthcare and
assures the monitoring and reporting of respective employees developmental
activity.
2.
Manages
quality improvement audits and training of designated coding staff.
3.
Acts
as expert coding resource not only to coders, clinical documentation
improvement, providers and revenue cycle, but also to specialty groups and
meetings.
4.
Acts as Super
user for all Coding-related Electronic Medical Record Systems necessary for
complete an accurate coding and EMR Data Governance. Updates policies and
procedures for those areas of responsibility. In-services appropriate staff
regarding changes in these areas.
5.
Develops
and maintains coding related policies, procedures, query development, work
queues and training materials in conjunction with management.
7.
Continually
communicates with Coding Staff, Medical Staff, Physician Advisor, Department
Chairman, and Department Administrators.
8.
Organizes,
facilitates, performs, tracks, trends, and reports on internal quality
reviews.
9.
Designs and
uses audit tools (i.e ROC) to monitor the accuracy of coding, documentation
gaps, and billing performed by Coding Specialists.
10.
Coordinates
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. (Includes, but not limited to, HIA quarterly
audits, ROC Compass audits, etc.)
11.
Coordinates
coding/documentation denial reviews and facilitates appeal letter formation. Includes,
but not limited to, RAC denials, insurance/3rd party payor denials,
etc.
12.
Communicates
regularly with the Coding Leadership on activities, problems, coding and/or
documentation issues and pending audits.
13.
Ensures audit
(external and internal) recommendations are completed (i.e. coding education,
coding changes, rebills).
14.
Extracts and analyzes from various
sources then develops action plan when necessary.
15.
Assist with
on-boarding of new Coding Specialists in regard to coding/quality related
policies, audits and initiatives.
16.
Updates Coding
Specialists on compliance and other regulatory changes.
17.
Keeps abreast
of coding changes, state and federal regulations and coding resources (i.e.
Coding Clinic)
18.
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. Utilizes all necessary systems as part of curriculum and educational
courses and administers exams. Involvement with testing and installation of
system upgrades when necessary to assure curriculum is up-to-date.
PHYSICAL
REQUIREMENTS: The
physical demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
1.
Must be able to sit for long periods
of time.
2.
Must have visual and hearing acuity
within the normal range.
3.
Must have manual dexterity needed to
operate computer and office equipment.
4.
Must be Able to lift, push or pull
10-20 pounds.
WORKING
ENVIRONMENT: The work
environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.
1.
Standard office environment.
2.
Visual strain may be encountered in
viewing computer screens, spreadsheets, and other written material.
3.
May require travel.
KNOWLEDGE,
SKILLS AND ABILITIES:
1.
Must possess excellent written and
verbal communication skills, as well as interpersonal skills necessary to
communicate effectively.
2.
Must possess the knowledge of related
provider healthcare compliance, revenue cycle operations, and auditing
techniques required.
3.
Must
possess the ability to mentor, educate and train others.
4.
Must
ensure quality and productivity standards.
5.
Must
be able to handle high stress and critical situations in a calm and
professional manner
6.
Must be able to concentrate and
maintain accuracy during constant interruptions.
7.
Must possess independent
decision-making ability.
8.
Must
possess the ability to prioritize job duties.
9
Must
be able to adapt to changes in the workplace and work assignments.
10.
Must
possess organizational and time management skills.
11
Must
possess the knowledge of anatomy, physiology and medical terminology.
12.
Must
possess analytical and problem solving skills.
13.
Must
be proficient in office software programs, including medical record and
billing systems.
14.
Must
possess the ability to analyze complex data and reports.
Date
Reviewed/Revised: December 2019