Coding Auditor/Educator

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.

Roles 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.

• Manages activities of designated coding personnel in training for WVU Healthcare and assures the monitoring and reporting of respective employee’s developmental activity.
• Manages quality improvement audits and training of designated coding staff.
• Acts as expert coding resource not only to coders, clinical documentation improvement, providers and revenue cycle, but also to specialty groups and meetings.
• 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.
• Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management.
• Continually communicates with Coding Staff, Medical Staff, Physician Advisor, Department Chairman, and Department Administrators.
• Organizes, facilitates, performs, tracks, trends, and reports on internal quality reviews.
• Designs and uses audit tools (i.e ROC) to monitor the accuracy of coding, documentation gaps, and billing performed by Coding Specialists.
• 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.)
• Coordinates coding/documentation denial reviews and facilitates appeal letter formation. Includes, but not limited to, RAC denials, insurance/3rd party payor denials, etc.
• Communicates regularly with the Coding Leadership on activities, problems, coding and/or documentation issues and pending audits.
• Ensures audit (external and internal) recommendations are completed (i.e. coding education, coding changes, rebills).
• Extracts and analyzes from various sources then develops action plan when necessary.
• Assist with on-boarding of new Coding Specialists in regard to coding/quality related policies, audits and initiatives.
• Updates Coding Specialists on compliance and other regulatory changes.
• Keeps abreast of coding changes, state and federal regulations and coding resources (i.e. Coding Clinic)
• 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.

Minimum Qualifications

Education, Certification, and/or Licensure

• Graduate of Health Information Technology (HIT) or equivalent program and Five (5) years of coding experience; OR 
• Medical Coding Certification Program and Five (5) years of coding experience; OR 
• High School Diploma or Equivalent and Eight (8) years of coding experience.
• Certification in one of the following: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), or CPC (Certified Procedural Coder).

Preferred Qualifications

Education, Certification, and/or Licensure

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

Experience

• 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.
• Previous supervisory or project management experience.