The Coding Educator/Auditor oversees coding education and auditing activities within healthcare settings, ensuring accurate use of ICD-10-CM and CPT coding systems across various services including emergency, inpatient, and outpatient care. They train coding staff, ensure compliance with federal and state regulations, and adhere to standards set by accrediting bodies such as CMS, AHIMA, and AAPC. The role requires extensive coding experience, knowledge of healthcare regulations, and valid professional coding credentials.
POSITION SUMMARY/RESPONSIBILITIES
Works under the direct supervision of the Coding Education & Audit Manager. Will perform any or a combination of the following types of coding education and audit: Basic ancillary services, Emergency Room services, Hospital Observation, Ambulatory surgery, Inpatient Admission. Utilizes the ICD-10-CM and CPT coding classification systems and ensures proper assignment and completion of Diagnosis and Procedure Coding on all cases. Trains new Coding Specialist(s), Technician(s), and Associate(s). Promotes the Health System’s guest relations’ policy. Complies with all Federal, State, local and accrediting bodies’ regulations and protocols. Accrediting bodies include, but not limited to, the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA) that promotes Healthcare Effectiveness Data and Information Set (HEDIS) metrics, Utilization Review Accreditation Commission (URAC), and the Joint Commission (TJC).
EDUCATION AND EXPERIENCE
Associate’s Degree is required; Associate’s degree in Health Information Management and/or Bachelor’s degree is preferred. Completion of a coding program is required. [Note: Completion of a coding program from the American Health Information Management Association (AHIMA) and/or American Association of Professional Coders (AAPCS) will be accepted. Completion of a coding program from other licensing bodies shall be accepted on a case by case basis and upon managerial discretion, with the approval of the Director of Revenue Integrity-Coding.] At least five (5) years of coding experience in professional services, hospital services, or a combination of both is required for external applicants. At least four (4) years of pro-fee, outpatient/ambulatory, and inpatient coding experience is required for internal applicants. Experience and working knowledge of 3M Encoding and Grouping software is required. Preference will be given to applicants with experience and knowledge of regulatory requirements, Microsoft Office products, and Epic EMR.
LICENSURE/CERTIFICATION
The Coding Educator & Auditor must maintain a valid credential offered by the accrediting bodies mentioned above (AHIMA and AAPC). [Note: Valid credential(s) from the American Health Information Management Association (AHIMA) and/or American Association of Professional Coders (AAPC) will be accepted. Credential(s) from other licensing bodies shall be accepted on a case by case basis and upon managerial discretion, with the approval of the Director of Revenue Integrity-Coding]. Licensure as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), and/or Registered Nurse(s) (RN) are highly preferred.
medical coding, ICD-10-CM, CPT coding, coding education, coding audit, health information management, healthcare compliance, hospital coding, coding certification, medical records
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