CODING OFF AUDITOR-EDU

5 days ago


Knoxville, United States Covenant Health Full time
Overview

Inpatient Coding Auditor and Educator, Centralized Coding

Full-Time, 80 Hours per pay period, Day Shift

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.

Position Summary:

Performs or reviews complex level internal coding auditing work for Inpatient/Outpatient and/or physician office accounts. Work involves leading or conducting coding and compliance audit projects for Covenant Health entities as they relate to coding, documentation, and billing compliance. Also provides consulting services to the organization’s management and staff and may coordinate requested coding investigations. Responsible for education and training for all Covenant coders, CDI, and/or physician office staff. Serves as a resource to coders, CDI staff, Quality and Case Managers, Decision Support, and physician office personnel regarding coding questions.

Serves on the ICD-10 Steering Committee for planning and implementation. Responsible for educating coders, CDI staff, and assisting with physician education for ICD-10.

Maintains all organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train Coding/CDI and physician office staff. Works independently with limited supervision with significant latitude for initiative and independent judgment. Reports to the Corporate Coding Manager or CFO of CMG as appropriate.

Responsibilities
  • Coding Audits/Education
    • Identifies and evaluates company risk areas and provides coding auditing procedures related to documentation and reimbursement.
    • Works with coders/CDI staff and/or physician office staff to educate and provide feedback.
    • Reviews and studies all information published by CMS and the OIG relative to coding, billing, and reimbursement compliance.
    • Reviews information from third-party payers relative to claims charging, coding, and billing.
    • Performs research and analysis of CPT coding, modifiers, and billing processes.
    • Communicates the results of coding audits and consulting projects via written reports and oral presentations.
    • Documents or reviews all audit activities; reports statistics and identified problems monthly.
    • Serves as a resource to hospital departments or physician practices to assist with coding and documentation questions.
    • Performs coding audits with regards to payor denials if necessary.
    • Works with health information management, Revenue Integrity, patient accounting, information systems, and other personnel to implement solutions.
    • Under the direction of Corporate Coding Manager and/or CFO of CMG, works with the Chief Compliance Officer on compliance issues.
    • Performs continuous audits or reviews to identify coding process improvement activities.
  • ICD-10 Education
    • Responsible for detailed ICD-10 training of coding/CDI staff and/or physician practices.
    • Responsible for assessing the preparedness of the coding/CDI staff for ICD-10 coding.
    • Responsible for concurrent auditing process between ICD-9 and ICD-10.
    • Responsible for specific physician training. Develop key indicators required for ICD-10 documentation for coding.
  • General
    • Maintains professional growth and development through continuing education, seminars, and applicable professional affiliations.
    • Recognizes situations which necessitate supervision and guidance, seeking appropriate resources.
Qualifications

Minimum Education:

None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification.

Minimum Experience:

Three (3) to five (5) years experience in acute care coding, both inpatient and outpatient and/or physician practice. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and regulations.

Licensure Requirements:

Certification in field of study. Acceptable certifications include RHIT/RHIA/AAPC, CPC, or CPMA.

Job Relationships:

Interactions With: Managed Care, Decision Support, CDI, Quality, Physicians, Finance, Information Systems, HIM, Revenue Integrity, and employees from other departments.

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