Outpatient Coding Educator/Auditor

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Outpatient Coding Educator/Auditor is an essential member of the Outpatient Coding Leadership structure. This role is responsible for developing an educational pathway for outpatient coders to grow and develop in their roles, and gain the coding expertise needed to advance through the coding career ladder from apprentice level to the more advance and experienced coders. This position is responsible for the development of a robust outpatient coding education program which extends to all aspects of outpatient coding, including coding claim edits and performs/coordinates quality assurance reviews to a high degree of coding quality within the department. In addition, this individual is responsible to conduct audits based on areas of risk in the outpatient space, results from audits/reviews according to a detail coding complaince work plan. Provides training and education and overseas coding and claim edit training and education within the department. This individual is the subject matter expert in the department for outpatient coding and works collaboratively with others on policies and procedures to ensure high quality and ongoing quality improvement.

EEO/AA/Disability/Veteran

• Coordinates activities with internal and external educational partners (Inpatient Coding Educator/Auditor, American Coding School, AHIMA Foundation Apprentice Program, Nosology, etc.) to: identify cases for internal audits, American Coding School and for apprentice staff on an ongoing basis; and meet with staff to assess their knowledge of specific coding topics and identifies those case types for review.
• Conducts and coordinates Quality Assurance reviews and other compliance audits, including rebuttal process and one-to-one discussions with coders, providing educational resources where necessary. Develops and provides individualized training based on audit findings for coders with suboptimal quality scores. Performs ongoing audits of coders with less than optimal coding quality and provide ongoing feedback until greater than 95% accuracy is attained. Conducts ad hoc audits on an ongoing basis. Provides coding audit outcomes to Coding management teams and develops a remediation plan.
  • Tracks the audits and education on an ongoing basis.
• Develops coding procedures and `how to' and "tips and tricks" guides for coders, and updates workflow procedures as needed.
• Surveys staff to determine areas where further instruction would be useful (i.e. spinal fusions, hysterectomies, etc.) and coordinates educational sessions to address these areas.
• Coordinates review and education of annual/regular ICD-10-CM and PCS/CPT code updates, deletions, additions as well as APC changes and any reimbursement/regulatory changes.
• Tracks all educational presentations developed internally as well as education log for staff and current proof of staff certifications. Communicates to coding leadership when certification, education and competency requirements are not being met by Coding staff.
• Coordinates on-boarding of new coders - tracking progress, identifying opportunities/resources to enhance staff's skill set, knowledge base, etc.
• Identifies inconsistencies, which may indicate potential problems, which could impact on department efficiency. Makes recommendations to streamline activities and procedures to support the coding unit.
• Responds to inquiries from other departments regarding coding; acts as a liaison to the billing office as a coding content expert.
• Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management.
• Leads training sessions and presents high-level education on coding guidelines/information to coders, which includes presenting PowerPoint presentations and webinar-type meetings. Coordinates training and orientation of new staff, as well as existing staff wishing to pursue promotion.
• Assesses coders' comprehension of training, and tracks and reports coding education results to coding leadership. Identifies need for one-on-one coding sessions and develops follow-up educational plans as needed. Collaborates with coding leadership to ensure coders receive sufficient and focused education.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a preceptor, mentor and resource to less experienced staff.
• Develops and performs audits to help determine and validate documentation and coding issues and gaps; analyzes audit results and identifies patterns, trends and variations in coding and documentation practices; and makes recommendations for improvement. Develops and implements training when educational needs have been identified.
• Maintains current knowledge of coding, federal and local regulations. Performs other duties as assigned.
• Performs coding functions as needed to maintain coding skills and maintain a comprehensive understanding of the coding workflows.

EDUCATION

• Bachelor's degree in HIM or related field or equivalent preferred.

EXPERIENCE

• Five (5)+ years progressively complex coding and/or auditing work experience required. A certified AAPC Instructor credential can be substituted in lieu of 2 year's of work related experience.
• Expert coding knowledge, including in-depth understanding of coding guidelines, conventions, CPT, and Evaluation & Management classification systems and knowing how to utilize resources available to answer questions.
• Experience with the electronic health record (EHR) and health care applications required. Epic experience preferred.
• Must have past experience with training and education in large and small groups.

LICENSURE

• Must be a certified coder through AAPC with a COC (certified outpatient coder) and either has or will have an instructor designation through the AAPC within six months.
• Additional coding certifications in the field highly desired.
• Must have or will have their CCC and CIRCC credential within first year.

SPECIAL SKILLS

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must possess well developed communication (written and verbal), analytical, and presentation skills.
• High level of competency with Microsoft Office tools.
• Advanced knowledge of disease processes, ICD-10, CPT and HCPCS coding applications, clinician documentation, and HIM department responsibilities of government regulations and areas of scrutiny for potential fraud and abuse.
• Ability to review analyze and interpret billing guidelines and state and federal regulations.
• Ability to create training material and presentations.
• Demonstrated ability to mentor, educate and train others.
• Possesses the ability to work with individual's at all organizational levels, particularly peers, team members and other departments.
• Advanced knowledge and understanding of anatomy, physiology, and medical terminology.

Originally posted on Himalayas