Divisional Coding Quality Auditor – Educator
AdventHealth
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Divisional Coding Quality Auditor and Educator
AdventHealth
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
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About the role
- Completes timely and accurate quality assurance audits while adhering to inpatient and/or outpatient coding policies, procedures, and established audit schedule
- Uses relevant references to perform audits, including ICD-10-CM and ICD-10-PCS, CPT, ICD-10-CM/PCS Coding Conventions, Official Coding Guidelines, CPT Assistant, AHA Coding Clinic®, CMS guidelines, NCCI guidance
- Provides outcomes of coding quality audit reviews with leadership
- Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact
- Assists with the facilitation of scheduled external audits
- Responds to inpatient or outpatient coding questions from assigned coders/providers and provides official inpatient coding references and guidelines
- Creates clear and accurate audit findings and recommendations in written audit reports used for advising and educating coders, auditors, managers, and directors
- Provides feedback to coding and CDI team members on escalated accounts
- Collaborates with providers, AH Clinical, CDI, inpatient and outpatient coding staff to assist with or resolve issues relating to medical record documentation and coding
- May participate in Iodine Retrospect inpatient reviews in partnership with CDI
- Provides feedback on the application of coding guidelines, practices, and proper documentation techniques, and data quality improvements
- Provides input on which quality audit and metrics will be tracked and visualized on shared dashboards
- Serves as point person for regional HIM/Coding teams to support quality audits and develop/ maintain reports, scorecards and dashboards
- Flags data or analytics limitations, employs critical thinking and creative problem solving to address barriers, and escalates issues to leadership when appropriate
- Documents and presents findings and trends from the quality audits to the HIM/Coding leadership
- Reports any compliance and/or risk issues to the compliance department
- Works with the audit team and coding manager to develop meaningful education and may conduct educational huddles for inpatient coders across the organization
- Makes recommendations to corporate coding leaders for coding policy/guideline changes, based on trending quality issues
- Works with Epic and AIT to identify automation and system enhancements as they pertain to coding
Requirements
- Completion of a coding certificate program or associate degree in HIM field
- 5+ years experience
- Thorough understanding of coding processes and workflows
- Expert level knowledge of disease pathophysiology and drug utilization
- Expert level knowledge of Medicare Severity Diagnosis-Related Groups (MS-DRG), and All Patient Refined Diagnosis-Related Groups (APR DRG), NCCI policy, OCE Edits, APCs
- Expert level knowledge of Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI), and Hierarchical Condition Categories (HCC)
- Expert level knowledge of medical terminology, coding guidelines and methodologies
- Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information
- Proficient in MS Office (Word, Excel, PowerPoint, Visio, Outlook, etc.) and familiarity with database programs
- Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient manner
- Ability to communicate professionally and effectively in English, both verbally and in written form
- Ability to follow complex instructions and procedures, with close attention to detail
- Epic experience
- Certified Coding Specialist Required or Certified Professional Coder Required or Certified Professional Coder Payer Required or Registered Health Information Administrator Required or Registered Health Information Technician Required
