[Hiring] Professional Coding Auditor-Educator @WVU Medicine

Role Description

Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers. Will also oversee or perform the overall auditing and education plans for the Coding staff.

This position will perform coding quality audits, provide ongoing feedback and education. This position utilizes various coding classifications; ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment.

Qualifications

• Graduate of a Health Information Technology (HIT) or equivalent program AND Five (5) years of coding experience; OR
• Graduate of a Medical Coding Certification Program AND Five (5) years of coding experience; OR
• High School Diploma or Equivalent AND Eight (8) years of coding experience.
• Certification in ONE of the following:
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Certified Outpatient Coder (COC)
• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC)

Requirements

• Bachelor’s degree in Health Information Management or related field (preferred).
• Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, and MS-DRG, HCC and APR-DRG assignment for Positions and multi-specialty coding, E&M coding, procedural/surgical coding.
• Knowledge of governmental billing and coding regulations including the “Teaching Physician Guidelines” for Professional Coding Positions (preferred).
• Previous supervisory or project management experience (preferred).

Core Duties and Responsibilities

• Manages activities of designated coding personnel in training for WVU Healthcare and assures the monitoring and reporting of respective employee’s developmental activity.
• Manages quality improvement audits and training of designated coding staff.
• Acts as expert coding resource to coders, clinical documentation improvement, providers and revenue cycle, specialty groups and meetings.
• Acts as Super user for all Coding-related Electronic Medical Record Systems necessary for complete and accurate coding and EMR Data Governance.
• Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management.
• Communicates with Coding Staff, Medical Staff, Physician Advisor, Department Chairman, and Department Administrators.
• Organizes, facilitates, performs, tracks, trends, and reports on internal quality reviews.
• Designs and uses audit tools (i.e ROC) to monitor the accuracy of coding, documentation gaps, and billing performed by Coding Specialists.
• Coordinates audits performed by outside agencies, acting as a liaison between agency and HIM personnel.
• Coordinates coding/documentation denial reviews and facilitates appeal letter formation.
• Communicates regularly with the Coding Leadership on activities, problems, coding and/or documentation issues and pending audits.
• Ensures audit (external and internal) recommendations are completed.
• Extracts and analyzes from various sources then develops action plan when necessary.
• Assists with on-boarding of new Coding Specialists regarding coding/quality related policies, audits and initiatives.
• Updates Coding Specialists on compliance and other regulatory changes.
• Keeps abreast of coding changes, state and federal regulations and coding resources.
• May be responsible for development and design of the curriculum for the WVU Healthcare Coding Certificate Program.

Physical Requirements

• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within the normal range.
• Must have manual dexterity needed to operate computer and office equipment.
• Must be able to lift, push or pull 10-20 pounds.

Working Environment

• Standard office environment.
• Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
• May require travel.

Skills and Abilities

• Excellent written and verbal communication skills.
• Knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques.
• Ability to mentor, educate and train others.
• Ensure quality and productivity standards.
• Ability to handle high stress and critical situations in a calm and professional manner.
• Ability to concentrate and maintain accuracy during constant interruptions.
• Independent decision-making ability.
• Ability to prioritize job duties.
• Adaptability to changes in the workplace and work assignments.
• Organizational and time management skills.
• Knowledge of anatomy, physiology and medical terminology.
• Analytical and problem-solving skills.
• Proficiency in office software programs, including medical record and billing systems.
• Ability to analyze complex data and reports.

Additional Job Description

• Scheduled Weekly Hours: 40
• Shift: Exempt/Non-Exempt: United States of America (Exempt)
• Company: SYSTEM West Virginia University Health System
• Cost Center: 539 SYSTEM HIM Provider Based Coding Analysis