Coding Auditor & Educator

Description

JOB SUMMARY
  • Audits medical record documentation and coding to extract data and determine appropriate ICD-10-CM/PCS and HCPCS codes for billing, internal and external reporting, and compliance with the Official Coding Guidelines for Coding and Reporting, payer regulations, and Clinic/hospital policy. Educates physicians and clinical personnel to ensure complete documentation in the medical record and queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices. Educates and trains coders to ensure both a working knowledge of coding and reimbursement guidelines and successful career ladder completion, including the development of training materials and reference documents. Researches audit results, error reports, and denials and resolves by successful appeal, staff education, and correction of discrepancies. Serves in an educational and advisory capacity to the coding staff, clinical staff, and physicians as it relates to documentation, coding, and regulatory compliance. The CBO coding Auditor/Educator reports to the CBO Coding Manager.
WORKING CONDITIONS
  • May be required to change from one task to another of different nature without loss of efficiency or composure.
  • Periods of high stress and fluctuating workloads may occur.
  • May be scheduled as needed including overtime.
  • General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
  • May be exposed to high noise levels and bright lights.
  • May be exposed to limited hazardous substances or body fluids, or infectious organisms.


Qualifications

EDUCATION REQUIREMENTS
  • 2 year / Associate's Degree in related field; In leu of Associates Degree, eight (8) years directly related experience (Required)
EXPERIENCE REQUIREMENTS
  • 4 years Experience with ICD-10, CPT, and HCPCS coding (Required)
  • If no degree, 8 years experience required.
  • 4 years Extensive knowledge of medical terminology (Required)
  • 4 years of related Revenue Cycle healthcare experience, preferably within coding and billing (Preferred)
  • Prior Athena or Meditech experience. (Preferred)
  • 3 years of experience in health information management or coding management in a physician practice/clinic setting (Preferred)
  • Experience with any of Phoebe Provider Group's legacy financial systems (Preferred)
CERTIFICATIONS AND LICENSURES
  • Required Certifications/Licensures: One of the following - CPMA, Certified Coding Specialist (CCS), Certified Coding Specialist, Physician (CCS-P), or Certified Professional Coder (CPC)
  • Preferred Certifications/Licensures: Experience with any of Phoebe Provider Group's legacy financial systems. 3 years of experience in health information management or coding management in a physician practice/clinic setting
GENERAL SKILLS
  • Organizational Skills
  • Communication Skills
  • Interpersonal Skills
  • Customer Relations
  • Mathematical
  • Analytical
  • Grammar / Spelling
  • Read /Comprehend Written Instructions
  • Follow Verbal Instructions
  • Basic Computer Skills
  • General Clerical Skills
PHYSICAL REQUIREMENTS
  • Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors
  • Have good - manual dexterity and eye-hand-foot coordination
  • Ability to perform - repetitive tasks/motion
PHYSICAL DEMANDS
  • Pushing/Pulling - Occasionally within shift (1-33%)
  • Lift/carry up to 20 lbs - Occasionally within shift (1-33%)
  • Lift/carry > 20 lbs with assistance - Occasionally within shift (1-33%)
  • Reaching above shoulder - Occasionally within shift (1-33%)
  • Lift/carry > 50 lbs with assistance - Occasionally within shift (1-33%)
  • Bending/Stooping - Occasionally within shift (1-33%)
  • Twist at waist - Occasionally within shift (1-33%)
  • Walking - Occasionally within shift (1-33%)
  • Standing - Frequently within shift (34-66%)
  • Climbing - Occasionally within shift (1-33%)
  • Sitting - Frequently within shift (34-66%)