Professional Coder Auditor and Educator

FLSA Status

Job Role Summary

This position completes timely and accurate auditing of coder and/or provider charges and clinical documentation and follows up with coder/provider education for Professional services as appropriate to facilitate compliant and optimized reimbursement, research, and PI initiatives. The Professional Coder, Auditor and Educator assists with workflow suggestions to Leadership.  
Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health values

Essential Functions and Responsibilities

•    Coding and Abstracting: Audits for appropriate diagnosis, codes for procedures, and evaluation and management (E&M) codes in accordance with coding guidelines and departmental standards; audits notes from providers to ensure the provider is coding in a compliant manner according to governmental rules and regulations; audits for the charge process, provides feedback to the coder and/or provider and meets with providers face-to-face to review documentation and coding guidelines as necessary; maintains acceptable levels of performance related to productivity and quality standards; engages in provider education opportunities
•    Captures charges accurately based on documentation, and integrates charges and codes appropriately; makes suggestions for additions to the fee schedules based upon recognition of new procedures and/or supplies
•    Problem Solving: Utilizes available resources appropriately to maintain quality and consistency in coding, abstraction, and charge entry processes; follows a defined process to query the medical staff for completion and/or clarification of documentation necessary to ensure coding compliance and accuracy; brings any concerns/issues to management's attention with examples within the same date of discovery; routinely meets with providers to help educate and review compliant billing practices
•    Medical Necessity: Recognizes cases that require specific medical necessity coverage diagnoses, and applies Local Coverage Determination (LCD) policies as necessary, and assists in educating providers and clinic sites to understand these rules; assists with workflow suggestions to Leadership to help improve the process and reduce denials
•    Assists with training of new physicians
•    Software Applications: Utilizes applicable software to retrieve documentation, abstract data/codes, and retrieve work lists

Job Requirements

• •    CCS, CCS-P or CPC required 
  •    Knowledge of and proficiency in the ICD CM, CPT and HCPCS II code assignment
  •    Three years direct coding experience 
  •    Educator experience preferred 
  •    Auditing experience preferred 

Knowledge, Skills & Abilities

• Knowledge of Local Coverage Determinations (LCDs), Correct Coding Initiative (CCI) edits related to Behavioral Health, and the healthcare billing process
• Knowledge of diagnostic and therapeutic tests, surgical procedures, and medical record documentation standards and retrieval
• Knowledge of E&M guidelines, Mental Health documentation requirements, and assignment of outpatient and in-patient facility and professional services
• Ability to apply medical necessity coverage determinations as applicable, and seek coverage in the medical record documentation
• General computer skills, and ability to learn new skills quickly
• Knowledge of computerized abstracting systems
• Knowledge of revenue cycle process
• Experience with clinical documentation improvement programs
• Experience in concurrent coding environment
• Excellent and professional oral and written communication skills
• Excellent and professional customer service and organizational skills
• Ability to work as an effective team member
• Ability to recognize opportunities for improvement and bring them to management's attention with suggestions
• Ability to set and adjust priorities to meet departmental goals
• Ability to work independently and exercise professional judgment to meet daily operational demands
• Demonstrates team oriented, professional conduct when resolving operational issues which cross operational units within Eskenazi Health