[Hiring] Outpatient Coding Educator/Auditor @Yale New Haven Health

Role Description

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 advanced 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 detailed coding compliance work plan. Provides training and education and oversees 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.

Responsibilities

• Coordinates activities with internal and external educational partners to identify cases for internal audits and assess staff knowledge of specific coding topics.
• Conducts and coordinates Quality Assurance reviews and compliance audits, providing educational resources where necessary.
• Develops and provides individualized training based on audit findings for coders with suboptimal quality scores.
• Surveys staff to determine areas where further instruction would be useful and coordinates educational sessions.
• Coordinates review and education of annual/regular ICD-10-CM and PCS/CPT code updates.
• Tracks all educational presentations developed internally and communicates to coding leadership when certification requirements are not met.
• Coordinates onboarding of new coders, tracking progress and identifying opportunities/resources to enhance skills.
• Identifies inconsistencies that may indicate potential problems impacting department efficiency.
• Responds to inquiries from other departments regarding coding and acts as a liaison to the billing office.
• Develops and maintains coding related policies, procedures, and training materials in conjunction with management.
• Leads training sessions and presents high-level education on coding guidelines/information to coders.
• Assesses coders' comprehension of training and tracks and reports coding education results to coding leadership.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education.
• Develops and performs audits to help determine and validate documentation and coding issues and gaps.
• Maintains current knowledge of coding, federal and local regulations and performs other duties as assigned.
• Performs coding functions as needed to maintain coding skills and understanding of coding workflows.

Qualifications

• Bachelor's degree in HIM or related field or equivalent preferred.
• Five (5)+ years progressively complex coding and/or auditing work experience required.
• Expert coding knowledge, including in-depth understanding of coding guidelines, conventions, CPT, and Evaluation & Management classification systems.
• 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.
• 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 the first year.

Requirements

• 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.
• 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 individuals at all organizational levels.
• Advanced knowledge and understanding of anatomy, physiology, and medical terminology.

Company Description