PPG Educator/Auditor

CBO Coding Auditor/Educator

Job Description

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.

Key Responsibilities

Perform audit on each coder every quarter to determine accuracy.

• An audit is performed for each coder on each patient type that they code.
• Clinic/outpatient would have 25-50 random encounters audited per coder. Inpatient profee would have 10-20 random encounters audited per coder.
• Educational feedback is provided to the coder and the supervisor based on the audit findings.
  
  

Provide education to the new coders as they join the team.

• Education includes patient type workflow along with the coding system workflow and review of coding guidelines.
• An audit is performed 1-2 weeks following the education to ensure that proper coding is being performed. Feedback is provided to the coder and supervisor.
  
  

Cross train/educate coders as they transition to a new or different patient type.

• Education includes patient type workflow along with the coding system workflow and review of coding guidelines.
• An audit is performed 1-2 weeks following the education to ensure that proper coding is being performed. Feedback is provided to the coder and supervisor.
  
  

Provide education packet to new providers.

• Education includes coding guidelines and specific guidance pertaining to their specialty.
• An audit is performed 1-2 weeks following the education to ensure that proper documentation and charging is being performed. Feedback is provided to the provider.
  
  

Perform audit on each provider annually.

• Retrospective audits-10 encounters from each month.
• Educational feedback is provided to the provider pertaining to audit findings.
  
  

Perform audit on providers and coders following any coding updates or changes.

• A sample audit is performed on coders and providers to ensure that the new coding updates are being implemented appropriately.
  
  

Cross train/educate other auditor-educators.

• Provide education pertaining to other patient types in order for the auditor to Assist supervisors with education opportunities for coders.
  
  

Assist supervisors with education opportunities for coders.

• Perform focused audits for supervisors on a coder pertaining to a particular high-risk area or short-term issue (modifier usage, high volume of HIM review concerns, etc.)
• Available to coders, supervisors, and physicians to assist in any coding questions or concerns.
• Perform annual OIG audits.
• Serves as the practice expert and go to person for all coding and billing processes
  
  

Requirements

MINIMUM EDUCATION REQUIRED:

Associates Degree and four (4) years directly related experience (Required). In leu of Associates Degree eight (8) years directly related experience (Required).

Minimum Experience Required

• 4 years Experience with ICD-10, CPT, and HCPCS coding (Required)
• 4 years Extensive knowledge of medical terminology (Required)
  
  

Minimum Licensure/Certification Required By Law

CPMA, Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), or Certified Professional Coder (CPC)

Preferred Qualifications

At least four (4) years of related Revenue Cycle healthcare experience, preferably within coding and billing, Prior Athena or Meditech experience. 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

Knowledge, Skills, And Abilities

Proven knowledge base in complete and accurate clinical documentation in all healthcare settings and for all healthcare disciplines

Demonstrated knowledge base and experience in acute care hospital and physician/clinic coding and billing practices.

Demonstrated knowledge of the conventions, rules, and guidelines for multiple classification systems, including ICD-10 diagnosis and procedures, CPT, and Evaluation & Management coding systems

Knowledge of multiple reimbursement systems (e.g., RHC, PFS, Medicare Severity-Diagnosis Related Groups (MS-DRG) and Ambulatory Payment Classification (APC)

Knowledge of clinical documentation improvement methodologies

Ability to accurately interpret and implement regulatory standards, including the National Correct Coding Initiative (NCCI) and Medically Unlikely Event (MUE) policies.

Ability to establish rapport with physicians and other healthcare practitioners.

Must have strong analytical and critical thinking skills to support problem solving and associated change management.