PB Outpatient Coding Educator/Auditor

The Coding Educator Auditor will coordinate coding audits and education functions of LCMC system coding services. This individual will be responsible for managing and working the edit and denial coding work queues for inpatient, outpatient and ambulatory and will provide coding feedback for education opportunities identified to the coding team. Prepares and presents educational programs related to coding. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.

Your Everyday

GENERAL DUTIES

• Reviews cases for accurate coding, monitoring the assignment and sequencing of ICD-10-CM/PCS and CPT codes to facilitate the correct assignment of diagnostic and procedure codes.
• Sequences diagnoses and procedures accurately according to coding principles.
• Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
• Works coding edits work queues and provides feedback and coding education to coding staff regarding completeness and accuracy of code assignment.
• Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.
• Reviews discrepancies between Clinical Documentation Specialist (CDS) DRG and the Coder DRG.
• Performs reviews in a timely manner to maintain DNFB within the assigned targeted goals.
• Assist in the development and provides ICD-10-CM/PCS, CPT/HCPCS, DRG (MS & APR) and APC auditing, coding and reimbursement training.
• Monitor and report the coders progress through the orientation and training processes.
• Establish timelines for training completion specific to level of training necessary.
• Keeps abreast of new regulatory requirements, annual revisions to the codes, etc. and applies this information appropriately.
• Works as subject matter expert and provides expertise when applicable.
• Performs and reports research on topics related to health information management, coding, billing and related compliance issues.
• Ensures audit findings and trends are investigated and education is prepared and reviewed with coding staff when necessary.
• Monitors changes in laws regulations, standards as they that affect coding, billing and related compliance.
• Reads, analyzes and interprets laws, regulations, policies and procedures governing the healthcare revenue cycle.
• Identifies potential areas of compliance vulnerability and risk, develops and identifies potential corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
• Prepares and distributes audit results/reports for the system coding program to Coding management staff.
• Works with coding Manager to improve coding services provided by coding staff.
• Assist system coding leadership with training and/or development of a performance improvement track for coding staff in the disciplinary process related to quality or productivity performance.
• Performs special coding –related projects as assigned.
• Other duties as assigned.

The Must-Haves

Minimum:

EXPERIENCE QUALIFICATIONS

• 5 years in physician and hospital coding, 2 years of coding audit (LCMC)
• Preferred: experience in Cardiology on PB or HB side

EDUCATION QUALIFICATIONS

• Required: Associate's Degree HIM (LCMC)

LICENSES AND CERTIFICATIONS

• Certification Name: Certified Inpatient Coder
  • Required
  • Issuer: American Academy of Professional Coders (AAPC)
  • Licensure Speciality: Specialty Certification
  • Entity: LCMC

• Certification Name: Certified Professional Coder
  • Required
  • Issuer: American Academy of Professional Coders (AAPC)
  • Licensure Speciality: Specialty Certification
  • Entity: LCMC

• Certification Name: Certified Coding Specialist
  • Required
  • Issuer: Commission on Certification for Health Informatics and Information Management (CCHIIM)
  • Licensure Speciality: Certification
  • Entity: LCMC

• Certification Name: Registered Health Information Technician
  • Issuer: Commission on Certification for Health Informatics and Information Management (CCHIIM)- AHIMA
  • Licensure Speciality: Certification
  • Entity: LCMC

• Certification Name: Registered Health Information Administrator
  • Issuer: Commission on Certification for Health Informatics and Information Management (CCHIIM)- AHIMA
  • Licensure Speciality: Certification
  • Entity: LCMC

SKILLS AND ABILITIES

• Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications and their effects on Coding practices today and in the future.
• High ethical standards.
• Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
• Experience in ICD-10-CM/PCS, auditing, coding and reimbursement training.
• Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
• Extensive knowledge of hospital and professional coding including provider based billing.
• Knowledge of documentation regulations of Joint Commission and CMS.
• Experience with concurrent coding reviews.
• Knowledge of medical terminology, classifications systems and vocabularies.
• Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
• Experience in assisting and identifying learning needs as well as providing education and training designed to support a learning organization.
• Strong analytical abilities and problem-solving skills.
• Excellent oral, written and interpersonal communication skills.
• Ability to organize and set priorities to ensure objectives are met in a timely manner.
• Ability to adapt to change and handle challenges proactively and with pose.
• Ability to effectively collaborate with physicians and managerial staff at all levels.