Leading Coding Auditor (VMG Coding Dept)
Provides leadership in sharing current and relevant coding subject matter expertise with staff. Performs audits of inpatient and/or outpatient coding. Understands and applies quality standards to all aspects of the documentation integrity program. Identifies areas for strategic audits, coding education and improvement. Supports denials management process and other initiatives.
Reviews documentation to ensure assigned codes are supported. Recognizes documentation clarification opportunities and works with team to secure additional documentation.
Assigns codes that most appropriately reflect documentation of the patient stay, severity of illness, risk of mortality, and resources utilized during the patient encounter.
Writes explanations to support or rebut coding recommendations and appeals for denied or downcoded encounters.
Participates in accurate data collection, analysis, evaluation, problem solving and recommendations of process improvements.
Performs pre and post-bill reviews, qualitative review and prospective third party payor reviews based on identified issues. Performs prebill reviews and education for new coders.
Performs data analysis of the audit program ,findings, and other source data, to identify trends and patterns. Creates detailed reports based on audit findings and facilitates change processes.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
MEDICAL CODING (EXPERT):
- The transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes.
MEDICAL TERMINOLOGY & DOCUMENTATION (EXPERT):
- The ability to comprehend medical terminology and documentation in an office, or surgical setting.
CRITICAL THINKING (ADVANCED):
- The objective analysis and evaluation of an issue in order to form a judgment.
- Understanding the rules, regulations, sanctions and other statutory requirements, guidelines and instructions relating to governing bodies and organizations, both internally and externally.
WRITTEN COMMUNICATION (ADVANCED):
- Demonstrates the ability to write clear, detailed, and comprehensive status reports, memos and documentation. Demonstrates an understanding of effective composition, such as having first line in a paragraph state the subject.
VERBAL COMMUNICATION (ADVANCED):
- Ability to enunciate clearly, using appropriate voice control and body language. Effectively transmits technical and business ideas and information to others. Listens carefully to ascertain points being made before trying to be understood.
PEER LEADERSHIP (INTERMEDIATE):
- The ability to show leadership and influence people of equal rank in an effort to accomplish team goals.
Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in.
Problem Solving/ Complexity of work:
Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others.
Breadth of Knowledge:
Has in-depth level of knowledge within a professional area and working knowledge of other areas.
May lead mid-sized projects; coaches and guides team members.
High School Diploma or GED (or equivalent experience) and 5 years relevant experience
Licensure, Certification, and/or Registration (LCR):
Must have one of the following coding certifications:
RHIT, RHIA, CPC, CCS, COC, CPC-H, CCS-P
Additional Qualification Information:
AAPC CPC, AHIMA CCS, CCS-P, RHIT or RHIA certification required.