HIS - Professional Coding Integrity Auditor & Educator - 40 hrs/wk

PURPOSE OF THIS POSITION

The primary purpose of the HIS Professional Coding Integrity Auditor & Educator is to support the integrity of the coding integrity program which is a key driver of accurate reimbursement, quality scores, benchmark data and statistical reporting.  The primary scope of responsibility includes claims derived from the HIS coding y team; however, may provide support in an advisory capacity to other divisions within BVHS, as appropriate. Implements educational opportunities in relation to current and upcoming coding guidelines and practices.  Collaborates with HIS Coding Auditor and Educator as well as leadership to ensure consistency within the HIS coding program, as applicable.

JOB DUTIES/RESPONSIBILITIES

• Duty 1: Participates along with coding leadership to develop and maintain coding-related policies and procedures to promote compliant and consistent coding practices, inclusive of ICD/DRG, ROM/SOI/APR-DRG, CPT/APC code assignments which are reflective and supported by clinical documentation.  Collaborates with Coding Integrity Auditor and Educator and coding leadership to ensure consistency between facility and professional coding policies and procedures, as applicable. Monitors and implements educational guidance in anticipation of changing organizational needs (e.g. implement a new service line) and/or in response to revised regulatory requirements (e.g. IPPS and OPPS annual updates, CPT Assistant, Coding Clinic, etc.).  Ensures appropriate dissemination of information and education to ensure coding team and/or any other pertinent individuals or departments remain current on coding policies and procedures.
• Duty 2: Regularly performs or coordinates the completion of coding quality reviews for accounts submitted by the HIS professional coding team.  Documents results, analyze data, identify issues and report findings to leadership of impacted areas.  Provides education in a peer-to-peer environment on audit findings and areas of opportunity to the Coding Integrity associate(s).  The Professional Coding Integrity Auditor & Educator helps facilitate ongoing follow-up auditing and education as a result of action plans.
• Duty 3: Assists in identifying clinical documentation opportunities that may impact the diagnosis and or CPT code assignments, including query appropriateness or opportunity.  Provides feedback to Clinical Documentation Integrity (CDIS) Specialist or clinical area, as appropriate. 
• Duty 4: Partners with Revenue Integrity, Patient Financial Services (PFS), and other areas, as appropriate, to conduct internal audits, as needed, of claims to ensure the accuracy and completeness of code capture (reconcile “hard” and “soft” coding); which is supported by clinical documentation.   
• Duty 5: Reviews and responds to third party payer audits related to code assignments.  Resolves identified issues; documents relevant decisions related to coding practice in policies or procedures to promote ongoing standardization and consistency.  Provides feedback to the coding team of identified coding opportunities through third party payer audits.
• Duty 6: Provides support and guidance to Corporate Compliance Department in audits or initiatives related to professional coding.   This may include participating in coding audits in response to an investigation or potential compliance risk, conducting coding research, offering advisory guidance to other BVHS entities, or interacting with third party consultants conducting a compliance review. 
• Duty 7:   Lends support to other departments, such as Quality, PMO, Case Management, or other organizational initiatives or projects where the coded data is a key driver in outcomes, benchmarking, or evaluation of the data being reported or utilized.  Serves as a member on committees, task force or projects as the coding representative, as necessary.
• Duty 8:   Develops and provides education to HIS Professional Coding Integrity Specialists other departments/associates, as necessary and medical staff (in collaboration with the CDI Specialists, Coding Integrity Auditor and Educator, as appropriate) regarding general coding education, regulatory updates, etc.  Tracks attendance and demonstrates competency of the participants of the course content. 
• Duty 9:   Participates in regular and active coding of various work types and works coding related edits, as time permits, to support the  HIS coding team as needed.
• Duty 10:   Performs second-level reviews prior to final coding when prompted by HIS Professional Coding Integrity Specialists, and acts as an organizational resource for coding-related questions. Utilize internal and external credible resources to investigate complex coding issues (e.g. conflicting coding guidelines, differing interpretation of guidelines, etc.) to provide guidance or recommendations to leadership to establish compliant coding practices.

REQUIRED QUALIFICATIONS

• College degree in a related field including, but not limited to health information management, a clinical profession, or 5+ years of experience from which comparable knowledge and abilities have been acquired.
• Certified Professional Coder (CPC) or Certified Coding Specialist – Physician Based (CCS-P) certification
• 5+ professional coding (hospital-based and non-hospital based clinic) experience (ICD and CPT)
• Proficient knowledge of professional charge and reimbursement methodologies
• General understanding of revenue cycle and reimbursement methodologies
• Proficient knowledge of regulatory requirements and compliance required; proficiency in researching coding issues (e.g. Coding Clinic, CPT Assistant, CMS website, etc.) required.
• Ability to provide education individually or to a group in a clear, concise and effective manner
• Must possess positive service-oriented and interpersonal skills; strong communication, including written and verbal presentation skills
• Ability to compile, analyze and effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership. 
• Ability to manage multiple tasks/projects.  Excellent organizational, time management and prioritization skills required.  Self-directed.
• Proven competence in utilization of computer applications, including Microsoft Office applications (Excel, Word, PowerPoint) and health-care related applications, including an Encoder

PREFERRED QUALIFICATIONS

• Certified Professional Medical Auditor (CPMA) certification
• RHIA, RHIT certification
• Facility coding experience
• Facility and/or professional billing knowledge
• Previous auditing experience
• Experience providing education in a peer-to-peer environment

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent activities in sitting, walking, lifting, bending, squatting, climbing, kneeling, twisting and standing. The associate must be able to lift 50 pounds or more and reach work above the shoulders. The individual must have excellent eye/hand coordination with the ability to grasp, push and pull, fine finger dexterity and manipulation. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.