Coding Auditor and Educator

Overview

Inpatient Coding Auditor and Educator, Centralized Coding

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary: 

Performs or reviews complex level internal coding auditing work for Inpatient/Outpatient and/or physician office accounts.   Work involves leading or conducting coding and compliance audit projects for Covenant Health entities as they relate to coding, documentation and billing compliance.  Also provides consulting services to the organization’s management and staff and may coordinate requested coding investigations.  Responsible for education and training for all Covenant coders, CDI, and/or physician office staff.  Serves as a resource to coders, CDI staff, Quality and Case Managers, Decision Support and physician office personnel regarding coding questions.

Serves on the ICD-10 Steering Committee for planning and implementation.  Responsible for educating coders, CDI staff and assist with physician education for ICD-10.

Maintains all organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train Coding/CDI and physician office staff.  Works independently with limited supervision with significant latitude for initiative and independent judgment.  Reports to the Corporate Coding Manager or CFO of CMG as appropriate.

Responsibilities

Coding Audits/Education

• Identifies and evaluates company risk areas and provides coding auditing procedures related to documentation and reimbursement to include: documenting client processes and procedures; assessing risks and adequacy of related manual and automated internal controls; developing criteria; reviewing and analyzing findings. If applicable, provides corporate oversight of any current departmental coding audit programs.
• Works with coders/CDI staff and or physician office staff to educate and provide feedback with Coding/CMG management to proactively train staff and respond to issues.
• Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance in order to ensure compliance.
• Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance.
• Performs research and analysis of CPT coding, modifiers and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payors and to maximize reimbursement.
• Communicates or assists in communicating the results of coding audits and consulting projects via written reports and oral presentations to coding management, audit committee, coding/CDI and or physician office staff as appropriate.
• Documents or reviews all audit activities; reports statistics and identified problems monthly or more urgently if deemed necessary.
• Serves as a resource to hospital departments or physician practices to assist with coding and documentation questions.
• Performs coding audits with regards to payor denials if/when necessary.
• Works in conjunction with health information management, Revenue Integrity, patient accounting, information systems and other personnel to assist with implementation of solutions to maintain a proper compliance stance.
• Under the direction of Corporate Coding Manager and or CFO of CMG, works with the Chief Compliance Officer relative to coding, billing and reimbursement compliance issues.
• Performs continuous audits or reviews, to identify coding process improvement activities and coding education opportunities for coding, CDI and/or physician office staff.

ICD-10 Education

• Responsible for detailed ICD-10 training of coding/CDI staff and/or physician practices.
• Responsible for assessing the preparedness of the coding/CDI staff for ICD 10 coding.
• Responsible for concurrent auditing process between ICD-9 and ICD-10.
• Responsible for specific physician training. Develop by physician speciality key indicators required for ICD-10 documentation for coding.

General

• Maintains professional growth and development through continuing education, seminars, and applicable professional affiliations to keep informed of industry trends.
• Recognizes situations, which necessitate supervision and guidance, seeking and obtaining appropriate resources.

Qualifications

Minimum Education:           

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.

Minimum Experience:         

Three (3) to five (5) years experience in acute care coding, both inpatient and out-patient and/or physician practice.  Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations. Experience in problem solving, analytical reviews, Must be knowledgeable in use of PC's, Windows, Excel and Word Processing; Must have good public relations, educational skills.

Licensure Requirement:      

Certification in field of study. The following certifications are acceptable-RHIT/RHIA/AAPC, CPC, or CPMA.