Ambulatory Coding Auditor Educator

DEPARTMENT: Physician Practice Management

FACILITY: Medical Office Building

WORK TYPE: Full Time

SHIFT: Daytime

SUMMARY:

Assess the educational needs of coding specialists and providers regarding coding and documentation and direct development of effective regularly scheduled educational programs that meet the needs of the health system. Serve as the primary resource to physicians for documentation and coding issues. Conduct ongoing coding and billing training programs for billing and coding specialists and providers. Creates presentations, develops learning material, handbook, and other training materials. Conducts coding and data quality reviews and prepares complex reports as required. Ensures all education activities comply with clinical billing standards and government regulation with concentration on hospital inpatient procedures, ambulatory, and specialty physician services.

RESPONSIBILITIES:

• Keeps abreast of pertinent federal, and state regulations and laws and Tift Regional Health System, Inc. ("TRHS") policies as they presently exist and as they change or are modified.
• Understands and adheres to: TRHS' compliance standards as they appear in TRHS's Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy; and HIPAA and TRHS policies regarding privacy and security of protected health information.
• Demonstrates the ability to perform tasks that meet the age-specific requirements of the persons, patients, vendors, and staff that the employee is charged to interact with as required by the position.
• Offers suggestions on ways to improve operations of department and reduce costs.
• Attends all mandatory education programs.
• Improves self-knowledge through voluntarily attending continuing education/certification classes.
• Maintains required competency levels as identified in written exams, skills checklists, skills labs, annual safety and health requirements as well as service excellence education hours requirements.
• Cross-trains in order to better assist co-workers and to provide maximum efficiency in the department.
• Volunteers/participates on hospital committees, functions, and department projects.
• Manages resources effectively.
• Reports equipment in need of repair in order to extend life of equipment and removes malfunctioning equipment out of service with timely reporting to the appropriate personnel.
• Makes good use of time so as to not create needless overtime.
• Responsible for coding education and standards development for ICD-10-CM/PCS, CPT, E/M and HCPCS codes for the health system.
• Prepares annual education and audit calendars at the beginning of each fiscal year and ensures timely and successful implementation of all education and audit activities.
• Demonstrates advanced knowledge of Diagnostic Related Groups (DRG).
• Demonstrates advanced knowledge of Risk of Mortality (ROM) and Severity of Illness (SOI).
• Applies knowledge of Present on Admission (POA) indicators to ensure accurate reporting.
• Applies advanced knowledge of Ambulatory Payment Classification (APC) in daily responsibilities.
• Ensures compliance with National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).
• Demonstrates advanced knowledge of Hierarchical Condition Categories (HCCs) to support accurate coding and reimbursement.
• Reviews, develops, and delivers training programs and educational materials to address deficiencies identified in the audits compliant with regulatory requirements.
• Demonstrates strong teaching, presentation, and communication skills
• Performs focused reviews and quality audits to ensure coding accuracy and compliance as directed by leadership and external customers.
• Provides written audit guidance by developing audit detail summary spreadsheets and reports to address any coding, documentation, and reimbursement impact.
• Provides training and education for newly hired coders; reviewing their coding, abstracting, and querying proficiency; tracking their progress; providing constructive feedback throughout the training period.
• Performs research and analysis of CPT coding, modifiers, and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payors and to optimize reimbursement.
• Monitors and evaluates the coding functions to ensure effective and efficient coding operations and compliance with established standards, rules, and regulations.
• Complies with AHIMA standards of ethical coding and coding compliance guidelines, along with all third party and government regulations.
• Serves as a clinical coding liaison and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical staff, clinical staff, clinical documentation team, and other departments as needed.
• Assists leadership to work on best practices to meet the coding training needs to include assistance with education and training of the Health Information Management Coding policies and procedures.
• Provides guidance to system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. determine appeal action, prepare appeal letter follow up and identify education issues.
• Reviews and responds to Payor Audits involving DRG and coding changes. Provide feedback with recommendations for improvement.
• Coaches and develops team members to achieve team goals that support business strategies and objectives. Responsible for assisting and improving employee performance using audit findings and approved quality processes.
• Audits for documentation opportunities to clarify confusing, incomplete, or conflicting information and obtain any additional documentation needed if needed.
• Assists patient financial services and clinical documentation improvement team members with questions on coding and billing edits.

EDUCATION:

• High School Diploma or Equivalent

CREDENTIALS:

• Registered Health Information Administrator
• Registered Health Information Technologist
• Certified Professional Coder
• Certified Coding Specialist
• Certified Professional Medical Auditor

OTHER INFORMATION:

Three (3) years' experience in coding practices in an ambulatory medical clinic and/or five (5) years' inpatient coding experience in an acute care hospital required.

Experience and working knowledge of 3M Encoding and Cerner software preferred.

One (1) year of coding audit experience preferred.

RHIA, RHIT, CCS, or CPC credential required. Certified Professional Medical Auditor (CPMA) preferred.

Southwell/Tift Regional Health System, Inc. is an Equal Opportunity Employer.