Under direct supervision of the Manager of Professional Services, performs functions as both coding auditor and educator and is responsible for providing oversight on education and audits of medical records for compliance with federal coding regulation and guidelines. This position is responsible for the coordination of auditing and education in support of achieving organizational strategic initiatives. The position has a shared responsibility to assist in achieving teams goals. Uses knowledge of PCH policies and procedures to provide a second level review of all Codes (CPT, EM, ICD-10 etc.) to achieve and maintain compatibility with Government and PCH billing requirements and compliance standards. This position also assists with coding production as needed; reviews and resolves coding issues related to billing, researches complex coding issues, and participates in process improvements related to coding and EM management.
Education
High School Diploma or equivalent. (Required)
Associates/Bachelor degree in Health care related field (Preferred)
Experience
Three or more years of experience in a hospital or professional entity (Required)
One year of Physician E/M Auditing experience. (Required)
Comprehensive knowledge of ICD-10-CM Official Guidelines for Coding Reporting, ICD and CPT/HCPCS coding classification systems, including facility and physician E/M, and hospital coding and reimbursement software. (Required)
Experience in developing training documentation and delivering training to individuals and groups. (Required)
Previous experience interacting with external/internal coding staff, auditors and leadership. (Preferred)
Certifications
CPC, CCS-P, CCS or RHIT or other accredited Coding credentials through AAPC or AHIMA (Required)
CPMA or other accredited Auditing certification through and accredited source such as the AAPC or AHIMIA (Preferred)
Special Skills
Medical Terminology and an understanding for the laws and regulations associated with medical records functions (Required)
Previous work with Auditing software (Preferred)
Versed in regulatory requirements for medical record documentation, as well as Medical staff Rules and Regulations where applicable (Preferred)