"Lighting a Path to the Future"

Quality Coding Auditor

Location: Oatfield, OR
Job Type: Direct Hire
Salary: $56,000.00 - $65,000.00
Degree: Associate of Science; Bachelor of Science;
Date: 11/30/2017
Job ID: 02529295
Job Description
Quality Coding Auditor (RELOCATION & SIGN-ON BONUS ELIGIBLE!)

Job description

The Quality Coding Auditor of Revenue Cycle will conduct monthly quality coding audits and report to the Program Manager. The audit will contain both a qualitative and quantitative focus, correct assignment of ICD-10-cm PCS 10-cm and CPT codes and clinician documentation to ensure that medical records meet all federal/state mandatory regulatory guidelines as well as internal controls.

Essential Responsibilities:
  • Provide identified documentation issues to Documentation Coding Services (DCS) educators regarding any gaps in documentation that facilitates coding issues.
  • Provide coding audit outcomes to Coding management teams. Work with the Coding management team to develop a remediation plan.
  • Develop and perform audits to help determine and validate documentation and coding issues and gaps
  • Analyze audit results and identifies patterns, trends, and variations in coding and documentation practices and make recommendations for improvement.
  • Develop and implement training when educational needs have been identified
  • Work with the Coding leadership in the development of policies and controls to support appropriate coding.
  • Work with the Revenue Cycle on other audits within the revenue service
  • Maintain current knowledge of coding, federal and local regulations. Perform other duties as assigned.
  • Qualifications:
Basic Qualifications:
Experience
  • Minimum three (3) years of coding experience of applying diagnoses and procedure codes to medical records, including Medicare, Medicaid, and third-party payor billings
Education
  • Associate's degree in health information management, business administration, finance, health administration or other related field OR two (2) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
License, Certification, Registration
  • Obtain Epic certification in one or more of Resolute Professional Billing or Resolute Hospital Billing Revenue Cycle sub-modules (i.e., Revenue Cycle, Charge Entry, Collections, Payment Posting, etc.) within one year after completion of required Epic courses.
  • Credential in one or more: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P) at time of hire/transfer.
  • Must maintain above registration or certification status.

Additional Requirements:
  • Extensive knowledge of ICD-10-CM and CPT coding and clinician documentation.
  • Knowledge of governmental coding regulations and areas of scrutiny for potential areas of risk for fraud and abuse.
  • Knowledge in both inpatient and outpatient medical coding.
  • Excellent interpersonal communication skills (written and verbal) to deal effectively with delicate, sensitive and/or complex situations with a wide variety of influential internal and external parties.
  • Excellent problem solving and time management skills.
  • Excellent customer service skills.

Preferred Qualifications:
  • Minimum five (5) years of applying diagnoses and procedure codes to inpatient and outpatient medical records, including Medicare, Medicaid, and third-party payor billings.
  • Minimum two (2) years in performing peer review audits and quality performance measures.
  • Experience with Microsoft Office, including Access, Excel, Word, and PowerPoint.
  • Bachelor's degree in health information management, business administration, finance, health administration or other related fields, OR four (4) years of experience in lieu of a preferred degree.
  • Current credential in one or more of the following: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), AHIMA ICD 10 trainer
  • A thorough working knowledge of disease processes, diagnostic and surgical procedures, ICD-10CM and CPT coding applications, and HIM department responsibilities of government regulations and areas of scrutiny for potential fraud and abuse.
  • Working knowledge of the Encoder, EpicCare, and KARE systems.
 




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