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Northeast Georgia Health System · 1 week ago

Coding Education / Quality Auditor - CPC and/or CCS-P - Mon - Fri Days - Hybrid

Oakwood, GA

Full-time

Hybrid

Mid Level

3+ years exp

Northeast Georgia Health System is committed to improving the health of its communities. They are seeking a Coding Education & Quality Auditor to conduct coding/billing/documentation audits, ensure compliance with coding standards, and provide education and recommendations to healthcare providers.

AssociationCommunitiesFitnessHealth Care

Responsibilities

Coordinates, schedules, performs the professional services documentation and coding audits of outpatient records for NGPG/NGHS

Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported

Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines

Audits every charge for new providers, PRN providers, locum providers, and any under compliance audit daily, till said provider passed an audit

Meets with the providers to review the audit findings and to recommend ways to improve when indicated

Orients and trains new providers throughout the year

Audit charts for accurate and correct coding and compliance within documentation guidelines and NGPG/NGHS policies

Prepares written reports of the audit findings by provider/practice

Follows up with providers as needed until documentation improves

Develops and coordinates educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates

Evaluates and provides appropriate documentation for the third party payer CPT denials to maintain the original CPT assignment, and when necessary, implement corrective action plan and/or educational programs to prevent similar denials and rejections from recurring

Maintains up to date knowledge of coding guidelines as they relate to professional services

Serves as a resource to the office staff, providers, and coding department

Provides clarification on NGPG/NGHS coding and compliance policies

Meets with the Coding & Compliance Department as needed to review the audits, discuss concerns, and make plans for processes/procedures

Assists with submission of charges/claims during high volume and/or end of month

Assists, as needed, with Coding Department work queues, deferrals, and claim edits

Conducts peer to peer audits and provides education for new Coding department employees, or as needed

Audits charts to ensure the NGPG/NGHS coding staff are utilizing the correct CPT, ICD-10, HCPCS, modifiers and other payor requirements as necessary

Handles coding issues escalated from other areas of the organization (A/R, customer service, etc.)

Conducts RL6 research, feedback and tracking for the coding department

Attends Regional and Local sponsored in-services and/or continuing education

Participates in professional development activities and maintains professional affiliations as necessary

Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars

Performs other job duties as assigned

Cross trains in other positions as requested

Qualification

CPC CertificationCCS-P CertificationICD-10 CodingCPT CodingMedical TerminologyMicrosoft OfficeAnalytical SkillsCommunication SkillsInterpersonal SkillsOrganizational Skills

Required

CPC and/or CCS-P Coding Certification

CPMA, CEMC or other Nationally recognized healthcare auditing certification required at hire, or required to obtain within 6 months of hire

High School Diploma or GED

Minimum three (3) years experience coding and/or auditing Multi-Specialty records required

Medical Terminology or Anatomy course required

Demonstrated experience in conducting education to providers and large audiences required

Detailed knowledge of ICD-9, ICD-10, CPT and HCPCS coding principles and medical terminology

In-depth knowledge of best practice coding policy and procedures

Highly skilled proficiency with Microsoft Office products, advanced proficiency in Excel and Powerpoint

Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences

Ability to organize data and provide detailed reporting

Ability to prepare presentations and present to large or small audiences

Must be highly motivated, organized, and a detail oriented individual

Excellent communication (written, verbal and presentation) and people-facing skills

Strong analytical and interpersonal skills

Ability to be a self starter/work independently and as a team player

Ability to travel to NGHS/NGPG sites on a regular bases

Understanding of current regulatory and third party requirements

Accuracy and attention to detail required

Establishes and maintains positive peer, leadership and customer relationships, interacting positively and productively with teams across organizational lines

Positive work ethic with proactive and team oriented style

Must possess a confident, friendly demeanor