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CODING AUDITOR & EDUCATOR

Bozeman Health
Bozeman

Job Description

The key job responsibility for the Coding Educator is the coordination of the following program elements: 1) administering the provider coding self-assessments, 2) Provide coding orientation and education to all providers, 3) Review audits and or quality reviews performed by the Coding Reviewer/Auditor 4) Assist with completing the Provider Review Summary. . Provider Coding Review Summary will be reviewed and communicated to Revenue Cycle leadership as well as Medical Directors. This position will work closely with the Coding Quality Review Specialist to report and educate based on schedule review intervals. This position shall also be an active member of the Coding Quality Review and Education Council, with expectation to present current findings and educational opportunities, as well as assist with the development of Coding Quality documents (tip sheets, educational material) for both providers and coders. Educator will maintain coding accuracy of 98%.

REQUIREMENTS

EDUCATION

Required:

High school graduate or equivalent required.

Preferred:

Associates or Bachelors Degree

LICENSURE and CERTIFICATION

Required:

Certification as a Registered Health Information Techinician (RHIT) or Registered Health Information Administrator (RHIA), Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS or CCS-P)

Preferred:

Certified Professional Medical Auditor (CPMA)

EXPERIENCE

Required:

3-5 years of professional coding experience, knowledge of medical terminology and diagnostic and procedure coding.

Extensive knowledge of coding guidelines. Must have knowledge of physician billing regulations, understanding of professional claims and billing procedures, fee schedule setup and reimbursement issues.

Requires working knowledge of computers and demonstrated proficiency in using email systems, internet and Microsoft Office software applications with emphasis on Word, Excel and Power Point.

Preferred:

Medical claims experience.

Computer and encoder application experience.

Knowledge of third party payor coding, billing and insurance principles and also understanding of Medicare and Medicaid regulations.

Auditing and education experience

KNOWLEDGE OF, SKILLS IN, ABILITY TO, COMPLEXITY AND DIFFICULY:

KNOWLEDGE OF:

KNOWLEDGE OF: Personal Computers, hardware and basic software programs including e-mail, word processing, and spreadsheets.

Medicare/Medicaid coding and billing rules and regulations.

Billing and accounting principles.

Healthcare Reimbursement processes/systems.

Classification Systems for: CPT, ICD-9CM & ICD-10CM/PCS, HCPCs

SKILLS IN:

Advanced oral and written communication skills.

Strong in clear and concise presentation of educational material in multi-disciplinary settings.

ABILITY TO:

Refer to policy manual for specific instructions/guidelines.

Follow established policies and procedures.

Adhere to the standards of the job description and overall philosophy of Bozeman Health.

Maintain flexibility to adapt to a variety of workload assignments

Coordinate and prioritize projects and programs

Perform and/or understand coding quality reviews and educate on findings

Work tactfully with the medical staff and hospital staff Work independently.

Create training material and or standard operating procedures to support coding and education

COMPLEXITY AND DIFFICULTY:

ESSENTIAL FUNCTIONS

60% Time Spent

Coordination of coding education as outlined in the Physician Coding Program Charter. Develop and maintain educational tools to support reviews for both provider and coding teams. Conduct educational sessions to summarize and report review findings according to schedule and identify/prioritize ad-hoc sessions for provider and coding teams. Make recommendations for improved workflows that lead to higher accuracy for both provider and coding teams.

10% Time Spent

Initiate development and formalize standardization of coding education, procedures and work-flows. Partner with Coding Quality Review Specialist in regards to review findings and follow-up tasks, including but not limited to: attending meetings/presentations and publishing of educational materials.

10% Time Spent

Maintain knowledge of State and Federal Regulations including but not limited to: CMS, Medicare Billing and Reimbursement regulations, understanding of the purpose of reviews/audits, coding guidelines/practices, payor regulations and behaviors

10% Time Spent

Maintain active involvement and attendance to the Coding Quality Review and Education Council meetings.

10% Time Spent

Assist in the recruiting, hiring, orientation development and evaluation of coding staff.

Employment Type

Full Time

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