Overview:
Your job is more than a job CThe 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.Everyday Responsibilities 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 obtained 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 coder's 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.
Minimum Qualifications:
EXPERIENCE QUALIFICATIONS 5 years in physician and hospital coding, 2 years of coding audit (LCMC).
Preferred Qualifications: Experience in Cardiology on PB or HB side. Education
Education Qualifications Required: Associate's Degree HIM (LCMC).
Licenses and Certifications:
Certified Inpatient Coder Required Issuer: American Academy of Professional Coders (AAPC) – LCMC (Licensure/Specialty: Certification).Certified Professional Coder Required Issuer: American Academy of Professional Coders (AAPC) – LCMC (Licensure/Specialty: Certification).Certified Coding Specialist Required Issuer: Commission on Certification for Health Informatics and Information Management (CCHIIM) – LCMC (Licensure/Specialty: Certification).Registered Health Information Technician Issuer: CCHIIM-AHIMA – LCMC (Licensure/Specialty: Certification).Registered Health Information Administrator Issuer: CCHIIM-AHIMA – LCMC (Licensure/Specialty: Certification).
Skills and Abilities:
Knowledge of electronic health record systems and their effects on coding practices.
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 PPS methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
Extensive knowledge of hospital and professional coding including provider-based billing.
Knowledge of Joint Commission and CMS documentation regulations.
Experience with concurrent coding reviews.
Knowledge of medical terminology, classifications systems and vocabularies.
Knowledge of privacy and security regulations and release of information practices.
Experience in identifying learning needs and providing education and training to support a learning organization.
Strong analytical and problem-solving skills.
Excellent oral, written and interpersonal communication skills.
Organizational skills with the ability to set priorities and meet deadlines.
Adaptability to change and proactive problem-solving.
Ability to collaborate with physicians and managerial staff at all levels.
Work ShiftDays (United States of America)
Additional Information:
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law. The above job summary describes the general nature and level of work and is not an exhaustive list of duties. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. NotesThis description retains the core responsibilities, qualifications, and requirements of the role while removing non-essential promotional content. It does not introduce new information or alter the meaning of the original job description.
