Divisional Coding Quality Auditor and Educator
AdventHealth
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Divisional Coding Quality Auditor – Educator
AdventHealth
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
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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; translates quality auditing results into practical recommendations for improvements in further standardizing audit policies and procedures actionable recommendations for improvement.
- Uses relevant references to perform audits, including but not limited to: International Classification of Diseases, Clinical Modification (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, etc.
- 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 that will be used for advising and educating coders, auditors, managers, and directors throughout the organization
- Will provide 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 to report outcomes and improve processes and workflows including programming requests, process changes, and staff accuracy and efficiencies
- Serves as point person for regional HIM/Coding teams to support quality audits and develop/ maintain reports, scorecards and dashboards that effectively tell the story of the data and highlight education opportunities in a manner that is easily understood and acted upon
- 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. Provides suggestions on process improvement.
- 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 that is confidential in nature (as needed to perform duties)
- 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
