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Covenant Health · 2 months ago

CODING AUDITOR-EDU-CLINIC

Knoxville, TN

Full-time

Hybrid

Mid, Senior Level

3+ years exp

Covenant Health is a managed medical practice organization with a wide range of specialties across East Tennessee. They are seeking a Coding Educator to provide consulting services, education, and training for coding staff while ensuring compliance with coding and billing regulations.

Health CareHealth InsuranceHome Health Care

Responsibilities

Provides consulting services to the organization’s management and staff and may coordinate requested coding investigations

Responsible for education and training for all Covenant coders, CDI, and/or physician office staff

Serves as a resource to coders, CDI staff, Quality and Case Managers, Decision Support and physician office personnel regarding coding questions

Responsible for educating coders, CDI staff, and assisting with physician coding and documentation education

Maintains all organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train Coding/CDI and physician office staff

Works independently with limited supervision with significant latitude for initiative and independent judgment

Identifies and evaluates company risk areas and provides coding education developing criteria, and reviewing and analyzing findings

If applicable, provides corporate oversight of any current departmental coding audit programs

Works with coders/CDI staff and or physician office staff to educate and provide feedback with Coding/CMG management to proactively train staff and respond to issues

Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance in order to ensure compliance

Reviews information from third party payers relative to claims charging, coding, and billing in order to ensure compliance

Performs research and analysis of CPT coding, modifiers and billing processes to ensure compliance with Medicare, Medicaid guidelines and other insurance payers and to maximize reimbursement

Routinely attends coding and documentation conferences and educational sessions to stay on top of coding and documentation changes and updates

Works with CDI Manager on annual coding updates

Serves as a resource to hospital departments and physician practices to assist with coding and documentation questions

Works in conjunction with health information management, Revenue Integrity, patient accounting, information systems and other personnel to assist with implementation of solutions to maintain a proper compliance stance

Under the direction of Corporate Coding Manager and or CFO of CMG, works with the Chief Compliance Officer relative to coding, billing and reimbursement compliance issues

Performs continuous reviews to identify coding process improvement activities and coding education opportunities for coding, CDI and/or physician office staff

Responsible for detailed ICD-10 training of coding/CDI staff and/or physician practices

Responsible for assessing the preparedness of the coding/CDI staff for ICD 10 coding

Responsible for concurrent review process for ICD-10 coding utilization

Responsible for specific physician training develop by physician specialty key indicators required for ICD-10 documentation for coding

Maintains professional growth and development through continuing education, seminars, and applicable professional affiliations to keep informed of industry trends

Recognizes situations which necessitate supervision and guidance, seeking and obtaining appropriate resources

Performs other duties as assigned or requested

Qualification

ICD-10 codingAcute care codingHealthcare billingCPT codingMedicare/Medicaid guidelinesCoding educationPublic relationsAnalytical reviewsWindows proficiencyExcel proficiencyWord ProcessingCertification in fieldProblem solving

Required

Must be located in East TN. Position is remote and onsite

Provides consulting services to the organization's management and staff and may coordinate requested coding investigations

Responsible for education and training for all Covenant coders, CDI, and/or physician office staff

Serves as a resource to coders, CDI staff, Quality and Case Managers, Decision Support and physician office personnel regarding coding questions

Responsible for educating coders, CDI staff, and assisting with physician coding and documentation education

Maintains all organizational and professional ethical standards and works with Covenant leaders to coach, mentor, and train Coding/CDI and physician office staff

Works independently with limited supervision with significant latitude for initiative and independent judgment

Reports to the Corporate Coding Manager or CFO of CMG as appropriate