Professional Coding Auditor-Educator

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Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff.
Responsible for the overall auditing and education plans for the Coding staff. This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Graduate of a Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience;

OR Graduate of a Medical Coding Certification Program AND Five (5) years of coding experience;

OR High School Diploma or Equivalent AND Eight (8) years of coding experience.

2. Certification in ONE of the following: 

• Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT) through American Health Information Management Association)  

• Certified Outpatient Coder (COC) through American Academy of Professional Coders 

• Certified Coding Specialist (CCS) through American Health Information Management Association 

• Certified Professional Coder (CPC) through American Academy of Professional Coders. 

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Health Information Management or related field.

EXPERIENCE:

1. Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, and MS-DRG, HCC and APR-DRG assignment for Positions and multi-specialty coding, E&M coding, procedural/surgical coding, as well as knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines” for Professional Coding Positions preferred.

2. Previous supervisory or project management experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Manages activities of designated coding personnel in training for WVU Healthcare and assures the monitoring and reporting of respective employee’s developmental activity.

2. Manages quality improvement audits and training of designated coding staff.

3. Acts as expert coding resource not only to coders, clinical documentation improvement, providers and revenue cycle, but also to specialty groups and meetings.

4. Acts as Super user for all Coding-related Electronic Medical Record Systems necessary for complete an accurate coding and EMR Data Governance. Updates policies and procedures for those areas of responsibility. In-services appropriate staff regarding changes in these areas.

5. Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management.

7. Continually communicates with Coding Staff, Medical Staff, Physician Advisor, Department Chairman, and Department Administrators.

8. Organizes, facilitates, performs, tracks, trends, and reports on internal quality reviews.

9. Designs and uses audit tools (i.e ROC) to monitor the accuracy of coding, documentation gaps, and billing performed by Coding Specialists.

10. Coordinates audits performed by outside agencies by obtaining accounts to be reviewed, acting as a liaison between agency and HIM personnel to gather data to be reviewed, facilitating exit conferences with Coding Specialists, and providing final reports to Coding Manager. (Includes, but not limited to, HIA quarterly audits, ROC Compass audits, etc.)

11. Coordinates coding/documentation denial reviews and facilitates appeal letter formation. Includes, but not limited to, RAC denials, insurance/3rd party payor denials, etc.

12. Communicates regularly with the Coding Leadership on activities, problems, coding and/or documentation issues and pending audits.

13.  Ensures audit (external and internal) recommendations are completed (i.e. coding education, coding changes, rebills).

14. Extracts and analyzes from various sources then develops action plan when necessary.  

15. Assist with on-boarding of new Coding Specialists in regard to coding/quality related policies, audits and initiatives.

16. Updates Coding Specialists on compliance and other regulatory changes.

17. Keeps abreast of coding changes, state and federal regulations and coding resources (i.e. Coding Clinic)

18. If needed this position could be responsible for development and design of the curriculum for the WVU Healthcare Coding Certificate Program, as well as other special projects regarding the overall Data Governance of the EMR to enhance coding. Utilizes all necessary systems as part of curriculum and educational courses and administers exams. Involvement with testing and installation of system upgrades when necessary to assure curriculum is up-to-date.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment.

4. Must be Able to lift, push or pull 10-20 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.

3. May require travel.

SKILLS AND ABILITIES:

1. Must possess excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively.

2. Must possess the knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.

3. Must possess the ability to mentor, educate and train others.

4. Must ensure quality and productivity standards.

5. Must be able to handle high stress and critical situations in a calm and professional manner

6. Must be able to concentrate and maintain accuracy during constant interruptions.

7. Must possess independent decision-making ability.

8. Must possess the ability to prioritize job duties.

9. Must be able to adapt to changes in the workplace and work assignments.

10. Must possess organizational and time management skills.

11. Must possess the knowledge of anatomy, physiology and medical terminology.

12. Must possess analytical and problem solving skills.

13. Must be proficient in office software programs, including medical record and billing systems.

14. Must possess the ability to analyze complex data and reports.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

539 SYSTEM HIM Provider Based Coding Analysis