Coding Educator & Auditor

Nebraska Methodist Hospital•Omaha, NE

3d•Onsite

About The Position

Responsible for the education, training and auditing of employees in the Coding department. This role involves developing training plans, conducting audits, staying updated on new government rules and regulations, organizing educational offerings, and serving as a resource for coding and reimbursement information. The position also requires cross-training staff, identifying documentation trends, and assisting with denial resolution.

Requirements

Minimum associates degree in Health Information Management or related field required.
Minimum of 5 years in coding of acute care inpatient services or hospital outpatient and/or professional services required.
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) and/or Certified Coding Specialist (CCS) or Certified Procedural Coder (CPC) or Certified Outpatient Coder (COC) required.
Certification as a Certified Professional Medical Auditor (CPMA) or Certified Inpatient Coding Auditor (CICA) required or must obtain within twelve months of hire.
Skilled in facilitating effective working relationships and building consensus.
Excellent attention to detail and completeness.
Must have strong knowledge in both payment methodologies (APC and DRG payment structures) to ensure maximum reimbursement.
Thorough knowledge of International Classification of Disease (ICD)-10-CM/Procedure Coding System (PCS) and Current Procedural Terminology (CPT) coding required.
Knowledge of computer systems and software used in functional area.
Capability to apply judgement and make informed decisions with little guidance.
Ability to communicate effective, both orally and in writing.
Ability to plan, organize, prioritize and work independently.
Ability to solve problems and identify solutions.
Ability to work effectively both as a team player and as a leader.
Must be able to handle frequent interruptions throughout the day.

Responsibilities

Responsible for training new hires and contract staff by developing training plan with a defined time frame for completion of training.
Inpatient Coding-ICD-10 Diagnosis and Procedure, as applicable.
Outpatient Coding, outpatient surgery and professional services, as applicable.
Current Procedural Terminology (CPT) coding, as applicable.
Performs audits during probationary period of new hires to ensure knowledge and understanding of coding guidelines and policies.
Responsible for the continuation of education in regards to new government rules, regulations, and yearly code updates for all jobs regarding I-10 coding and CPT coding.
Researches new coding updates.
Reviews CMS mandates and updates coding directives as needed.
Reviews Federal Register to ensure compliant coding and reporting.
Organize education offerings for inpatient and outpatient coding staff as well as related jobs regarding coding and reimbursement.
Has the ability to present information in a quick manner while still getting pertinent information distributed.
Manages training supply needs, room reservations, and catering (if needed).
Works with management to identify annual CEU offerings for inpatient and outpatient coders.
Works closely with the Coding Leadership.
Per direction of Coding Team Manager: reviews and formulates processes for each coder to ensure efficient use of the medical record to ensure productivity standards are being met.
Cross trains current staff in all processes in their respective job descriptions.
Contributes to the development and maintenance of specialty-specific coding education materials.
Identifies documentation trends and issues to bring forward for resolution
Serves as a resource for other departments, physicians and other requestors of education and information on ICD-10.
Serves as a coder when volumes exceed department standards as determined by management.
Performs audits on inpatient or outpatient coders as directed by management.
Develops and maintain audit spreadsheet for each coder, auditing frequency to be determined in coordination with Coding management.
Develops individualized education/training plan in coordination with Coding management based on the results of the audits.
Outpatient Education Coordinator/Auditor will resolve APC Edits using CSG Edit Report to ensure all accounts reflect appropriate Current Procedure Terminology (CPT) codes, modifiers, and units of services to facilitate correct outpatient billing as defined by Medicare.
Works in collaboration with Business Office on denials by reviewing submitted charges and coding; resolve issues to enhance account payment timeliness.