Outpatient Coding Auditor

Emory•Atlanta, GA

4d•Onsite

About The Position

Responsible for implementing and maintaining a compliance plan for outpatient coding and reimbursement. The Outpatient Coding auditor will assist the Coding Manager with Outpatient and Emergency Coding Services, and the development of policies and procedures. Develops education and Supervises programs regarding elements of the HIM Compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff, physicians, billing personnel and ancillary departments. Coordinates and conducts continual reviews, tracking and trending following the outpatient coding audits. Educates new outpatient coders on documentation requirements including how to read an outpatient medical record and extrapolate the required documentation with regards to outpatient surgery coding. Educate outpatient coders on ICD-10-CM guidelines, coding conventions and Coding Clinics pertinent to outpatient surgery coding. Educate outpatient coders on CPT/HCPCS guidelines, coding conventions and CPT Assistant pertinent to outpatient surgery coding. Educate outpatient coders with regards to pertinent coding policies and procedures. Conduct quality review of coding to assure accurate codes, APC assignment, and accurate reimbursement. Summarize quality monitoring results to support performance appraisals and process improvement activities. Research and respond to outpatient coding questions. Work the daily unbilled report to ensure timely coding. Review quality audit results with individual associate and conduct follow up review to assure resolution. Act as liaison with PFS department to resolve all outpatient coding review requests.

Requirements

Certified Coding Specialist (CCS) certification required.
Minimum 4 years' experience with coding ICD-10 in an acute care setting.
Minimum 2 years of experience in performing APC coding audits.
Knowledge of APC and grouping methodologies; in particular what diagnoses / procedures APC assignment.
Basic computer skills in word processing and spreadsheet utilization.
Excellent interpersonal skills to develop relationships necessary to facilitate and educate.
Excellent prioritization and organizational skills.

Responsibilities

Implement and maintain a compliance plan for outpatient coding and reimbursement.
Assist the Coding Manager with Outpatient and Emergency Coding Services, and the development of policies and procedures.
Develop education and supervise programs regarding elements of the HIM Compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel.
Coordinate and conduct continual reviews, tracking and trending following the outpatient coding audits.
Educate new outpatient coders on documentation requirements, ICD-10-CM guidelines, CPT/HCPCS guidelines, and pertinent coding policies and procedures.
Conduct quality review of coding to assure accurate codes, APC assignment, and accurate reimbursement.
Summarize quality monitoring results to support performance appraisals and process improvement activities.
Research and respond to outpatient coding questions.
Work the daily unbilled report to ensure timely coding.
Review quality audit results with individual associates and conduct follow-up reviews to assure resolution.
Act as liaison with PFS department to resolve all outpatient coding review requests.