Coding Auditor

Remote
Temporary
Salary: $54.00 /hour


CONTRACT TO PERM!!!!

TENTATIVE- FULL TIME 40 HOUR WORK WEEK

SUTTER HEALTH- REMOTE

PAY: 40.80

REQUIRED:

  • Certified Health Information Tech, Health Information Admin and/or Certified Coding Specialist .
  • 5 years of Demonstrated experience and a proven track record in coding, training, and/or service development in a facility of significant size and complexity.
  • Demonstrated experience in the fundamentals of auditing and monitoring
  • Experience executing Coding Quality Assurance standards, processes, policies, procedures and service level agreements.
  • Experience participating in planning new or expanded services and managing projects.
  • In-depth knowledge of Diagnosis Related Groups, Ambulatory Payment Classifications, ICD-9-CDM, and Current Procedural Terminology.
  • Coding systems and related coding issues including charge capture and evaluation and management leveling
  • General knowledge of Revenue Cycle applications, including Electronic Health Record systems.
  • General knowledge of how to conduct a quality control audit.
  • Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
  • Familiarity with Coding management functions in acute and non-acute settings.
  • Knowledge of Patient Management information system applications, preferably EPIC.

Desired : Certified Clinical Documentation Specialist.

Experience:

  • Demonstrated experience and a proven track record in coding, training, and/or service development in a facility of significant size and complexity, hospital business operations, information systems, and coding applications, as typically acquired in 3-5 years of experience Demonstrated experience in the fundamentals of auditing and monitoring
  • Experience executing Coding Quality Assurance standards, processes, policies, procedures and service level agreements
  • Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships preferred Experience participating in planning new or expanded services and managing projects

Knowledge:

  • In-depth knowledge of Diagnosis Related Groups, Ambulatory Payment Classifications, ICD-9-CDM, and Current Procedural Terminology Coding systems and related coding issues including charge capture and evaluation and management leveling In-depth knowledge and understanding of coding compliance and quality assurance.
  • Familiarity with medical terminology and the medical record coding process
  • Strong working knowledge of anatomy, physiology and pharmacology
  • General knowledge of Revenue Cycle applications, including Electronic Health Record systems General knowledge/ awareness of all areas related to Coding and how they interrelate General knowledge of how to conduct a quality control audit
  • Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections
  • Familiarity with Coding management functions in acute and non-acute settings
  • Knowledge of Patient Management information system applications, preferably EPIC

Skills:

  • Ability to quality check other’s work and compile audit reports based on findings
  • Ability to provide coaching and feedback to Coders if quality assurance results are subpar
  • Ability to train staff and resolve issues in a virtual environment
  • Ability to work closely with medical staff and other departments to create a complete and accurate database of clinical and demographic data while ensuring appropriate coding
  • Ability to run reports needed to improve patient care
  • Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery
  • Requires strong accuracy, attentiveness to detail and time management skills for translating complex medical documentation into diagnostic classification system codes
  • Aptitude to conceptualize, plan, and implement stated goals and objectives
  • Ability to manage own schedule and responsibilities. Must have initiative to work effectively without constant supervision and direction, meeting all deadlines
  • Ability to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles.High-level problem identification/ mitigation/ resolution and analytical skills
  • Ability to develop effective working relationships/ networks within and outside the organization
  • Excellent ability to communicate ideas both verbally and in writing to influence others using on-on-one contact, formal presentations, and group discussions
  • Ability to recognize the appropriate style, level of detail, and message for the audience
  • Computer keyboarding skills and experience with computerized coding/abstracting systems and encoders
  • Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite
  • Ability to learn new applications/software systems effectively and efficiently
  • Ability to comply with Sutter Health policies and procedures
  • Requires the ability to work with and maintain confidential information

Over all Duties:

  • Performs quality reviews of Coding staff work activities to ensure compliance with Coding guidelines and policies.
  • Analyzes findings from quality reviews of coding staff, and other relevant coding data, in order to provide feedback and support for training and clinical documentation improvement efforts. Provides audit results to Coding Team leads and shared recommendations for course-correction and education as needed.Supports the success of a high-performing shared services organization by helping to champion and drive the long-term
  • Sutter Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.
  • Participates in programs and in using tools in support of building a high performance culture via the standard Sutter Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.).
  • Leads, coordinates and performs all functions of quality reviews (routine, new hire, pre-bill, policy driven) for inpatient and outpatient coding
  • Assists in ensuring Coding staff adherence to coding guidelines and policies by monitoring results and providing feedback to Coding staff, Coding Team Leads, and Coding Education Specialists
  • Works closely with Coding Education Specialists in drafting education material as follow up to audit findings
  • Performs second level reviews on identified Hospital Acquired Conditions and Core Measure diagnoses not present on admission by reviewing the account and notifying the Coding staff if they agree with the diagnosis, if they recommend a physician query, or if they need to contact the Quality department for further input-Provides service and feedback to the Quality Departments in relation to Quality Metrics
  • Analyzes changes in Midas data trending and develops reports and recommendations to address issues
  • Performs quarterly analysis of coding data, develops reports and recommendations to address issues
  • Prepares and presents reports of findings, identifying trends or areas of opportunity for coding and documentation improvement
  • Coordinates meetings with Clinical Documentation Specialists at designated Affiliates and provides feedback and support as it relates to coding and documentation improvement, to include trending of queries, communication between Health Information Management Coding and Clinical Documentation Improvement on problem areas/physicians, and monitoring of appropriate query completion and response
  • Provides feedback to support departments regarding identified charge errors; this may include providing feedback to/coaching of individual Coding staff members
  • Participates with Denials Management as necessary to review and respond to external coding audits and Recovery Audit Contractor reviews-Provides feedback to Service Line Specialists, departments and Charge Description Master team regarding identified charge errors,
  • Coordinates with affiliate Case Management departments to resolve process issues affecting coding quality and operations Under supervision of the Coding Quality Team Lead, works with IT support to produce and submit the data submissions and edit resolutions for the Office of Statewide Health Planning and Development
  • In initial year, participates in cross-training and job enlargement opportunities for Major job responsibilities. Works with direct supervisor to identify minor set of responsibilities to develop and perform in support of peaks, valleys and cycles across the Shared Services Organization and individual career growth opportunities. Performs both Major and Minor responsibilities after initial year
  • Continuous Improvement-Supports the implementation of programs, policies, initiatives, and tools specific to the Shared Services Organizational process owned by Operations Support across the Shared Services Organization. Participates in all others as appropriate-Contributes ideas and actions towards the continuous improvement of Coding related processes within area of influence
  • Performance Management
  • Ensures delivery of business results by meeting or exceeding all individual operating metrics
  • Plans and communicates potential issues to his/her team leader as appropriated organizes work so Individual Operating Metrics and Service Level Agreement objectives are realized
  • Adapts to learning new processes, concepts, and skills-Seeks and responds to regular performance feedback from team lead; provides upward feedback as needed
  • Assists in orientation and appropriate training of team members, helps cross-train peers in minor responsibilities; acts as a mentor to peers
  • Relationship Management-Maintains positive working relationships with members of other teams in the Shared Services Organization to communicate effectively and to ensure compliance with cross-team responsibilities
  • Assists in ensuring efforts of the Coding Education & Quality Assurance Team support building strong peer-to-peer relationships

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