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Wellstar Health System · 2 hours ago

Lead Coding Services Auditor

Atlanta, GA

Full-time

Onsite

Mid, Senior Level

3+ years exp

Wellstar Health System is dedicated to enhancing the health and well-being of every person they serve. The Lead Coding Services Auditor is responsible for conducting audits and reviews to ensure compliance with coding guidelines and regulations, while also mentoring the auditing team and providing expert feedback.

FitnessHealth Care

Responsibilities

Perform lead duties in support of team in regard to data and reporting to include but not limited to: produce monthly reports and maintains dashboards from multiple systems, maintains other logs and spreadsheets (i.e.: CFB email, PSI log), maintain updated data needed by team (i.e.: Vizient Data), update written processes as directed by Data Quality Manager

Collect and appropriately record data in auditing software and/or spreadsheets to include but not limited to: Cloudmed, EPIC, Institutional Audit Manager (IAM), and other spreadsheets at accuracy

Work assignments in accordance with leadership direction communicate any outstanding negative impacts on CFB or work left undone

Follow verbal and written processes and instructions

Communicate messages verbally and via email in a manner to achieve an objective

Capture troubleshoot on reported IT issues for the team to resolution serve as a Superuser for testing and updates for systems utilized by the team Perform Prebill and Retrospective Reviews:

Validate assigned ICD-10-CM/PCS codes, abstracting data elements and DRGs are correct/appropriate according to official coding guidelines and supported by clinical documentation in the medical record. Performs audits at a minimum accuracy and productivity rate upon completion of audit

Validate abstracting data to include but not limited to: POA, Point of Origin, Admission source, discharge disposition is correct

Validate adherence to WellStar Coding Policies and Procedures

Validate adherence to Wellstar Coding Query Policy

Review and identify coding opportunities on mortality accounts using validation criteria from Vizient Risk Adjustment Calculator tool as well as other sources

Identify query opportunities or other documentation improvements on reviews

Serve as the department PSI (Patient Safety Indicator) subject matter expert for coding abstracting accuracy impact(s) based on AHRQ inclusion and exclusion criteria for PSIs

Performs lead responsibilities in support of team in regard to audit reviews to include but not limited to: focused reviews, audit the auditor reviews, rebuttals. Provides verbal and written trending data citing opportunities and feedback for process improvements Onboarding, Education Mentoring:

Onboard new Coding and Auditor staff. Oversee lead any onboarding performed by any outside vendor(s)

Lead communication with the appropriate internal and external stakeholders relevant to auditing results education plans

Communicate feedback to Coding CDI leadership as well as Coders on areas of opportunity relevant to coding, abstracting and documentation opportunities both verbally and through data reporting

Participates in creation and roll out of action and process improvement plans to address opportunities

Prepare educational materials, instructions and tip sheets for Coding and CDI teams, as necessary

Serve as a subject matter expert for owning area, participate in meetings communicate coding knowledge complexities with internal and external stakeholders to include the CDI team

Review and stay abreast of the latest state and federal regulatory guidelines, Official Coding Guidelines, official coding advice (coding clinic) and all coding updates. Communicate understanding, impacts implications for WHS

Serve as a mentor for the team Coding Abstracting Accounts:

Accurately and completely assign appropriate ICD-10-CM/PCS and/or CPT/HCPCS codes to the greatest specificity with a minimum accuracy rate in accordance with Coding and WHS guidelines

Accurately and completely abstract all required data into the appropriate data fields in compliance with statistical data requirements with a minimum of accuracy rate

Meet productivity standards

Query physicians to further clarify code assignments, as necessary

Qualification

ICD-10-CM/PCS codingDRG validationAuditing experienceMedical terminologySoftware proficiencyCritical thinkingOrganizational skillsMentoringCommunication skillsProblem-solving

Required

Associate's Degree in Health Information Management, Business, or other health care related field Required

Minimum 1 year Served in a Coding Auditor Role at Wellstar for at least one year, is fully trained and maintains a accuracy in all areas within scope of work Required

Minimum 3 years Hospital-based inpatient auditing experience currently meeting a accuracy in abstracting, coding and DRG assignment while meeting productivity requirements or passing score on the coding assessment provided by Coding department, if applicable. Required

Extensive knowledge of medical terminology, disease processes, pharmacology, anatomy and physiology. High

Must have excellent organizational skills and be able to manage multiple tasks at one time, set priorities and achieve goals timely. High

Ability to learn and efficiently use various software systems: EPIC, 3M360, Institutional Audit Manager, Vizient, Cloudmed, Outlook, Teams and text messaging. High

Ability to articulate & communicate verbally & via email to achieve an objective & with critical thinking skills High

Able to identify creative, out of the box solutions to complex problems, analyze issues and opportunities to achieve and provide feedback and implement solutions to achieve a successful result. High

Serve as a mentor to the team, taking time to assist and being a source of information and insight. Provide an exchange of knowledge, experience and goodwill to assist in growth for the team member High