Coding Education Quality Auditor-Hybrid
Company: Northeast Georgia Health System, Inc
Location: Oakwood
Posted on: May 28, 2023
Job Description:
Job Category:Revenue Cycle
Work Shift/Schedule:VariesNortheast Georgia Health System is rooted
in a foundation of improving the health of our communities. About
the Role:Job SummaryCoding Education & Quality Auditors (CEQA)
conduct coding/billing/documentation audits of all NGPG/NGHS
Providers to determine organizational integrity of coding/billing
for professional services, including detection and correction of
documentation, coding and billing errors. Audits consist of
evaluation of the adequacy and accuracy of documentation to support
services billed including ICD-9/ICD10/CPT/HCSPCS and other
third-party payer codes. CEQAs ensure the medical necessity of
services, compliance with other documentation, coding and billing
standards. CEQAs apply standardized audit scoring methodology to
evaluate consistency of documentation and coding, and standardized
audit findings methodology to report audit results. CEQAs
communicate audit results to physicians, physician leadership,
senior management, Compliance department and staff. -CEQAs are
required to provide physician and coder education, and make
recommendations to management for corrective action. -CEQAs serve
as an institutional subject matters expert and resource on
interpretation and application of documentation and coding rules
and regulations. CEQAs assure the quality of the coding
documentation fits service and codes, and any missing labels on
documentation are corrected. - -Minimum Job Qualifications
- Licensure or other certifications: CPC and/or CCS-P Coding
Certification. CPMA, CEMC or other Nationally recognized healthcare
auditing certification required at hire, or required to obtain
within 6 months of hire.
- Educational Requirements: High School Diploma or GED.
- Minimum Experience: Minimum three (3) years experience coding
and/or auditing Multi-Specialty records required; Medical
Terminology or Anatomy course required. Demonstrated experience in
conducting education to providers and large audiences
required.
- Other:
Preferred Job Qualifications
- Preferred Licensure or other certifications:
- Preferred Educational Requirements:
- Preferred Experience:
- Other:
Job Specific and Unique Knowledge, Skills and Abilities
- Detailed knowledge of ICD-9, ICD-10, CPT and HCPCS coding
principles and medical terminology
- In-depth knowledge of best practice coding policy and
procedures -
- Highly skilled proficiency with Microsoft Office products,
advanced proficiency in Excel and Powerpoint
- Ability to communicate (both verbally and written) technical
coding information to both technical and non-technical
audiences
- Ability to organize data and provide detailed reporting
- Ability to prepare presentations and present to large or small
audiences
- Must be highly motivated, organized, and a detail oriented
individual
- Excellent communication (written, verbal and presentation) and
people-facing skills
- Strong analytical and interpersonal skills
- Ability to be a self starter/work independently and as a team
player
- Ability to travel to NGHS/NGPG sites on a regular bases
- Understanding of current regulatory and third party
requirements -
- Accuracy and attention to detail required
- Establishes and maintains positive peer, leadership and
customer relationships, interacting positively and productively
with teams across organizational lines.
- Positive work ethic with proactive and team oriented style
- Must posses a confident, friendly demeanor -Essential Tasks and
Responsibilities
- Coordinates, schedules, performs the professional services
documentation and coding audits of outpatient records for
NGPG/NGHS.
- Evaluates the quality of clinical documentation to identify
incomplete or inconsistent documentation that could impact the
quality of data being reported.
- Audits codes and professional fee services performed by
providers from medical records according to ICD-10, CPT, HCPCS, and
CMS guidelines.
- Audits every charge for new providers, PRN providers, locum
providers, and any under compliance audit daily, till said provider
passed an audit. -
- Meets with the providers to review the audit findings and to
recommend ways to improve when indicated.
- Orients and trains new providers throughout the year.
- Audit charts for accurate and correct coding and compliance
within documentation guidelines and NGPG/NGHS policies.
- Prepares written reports of the audit findings by
provider/practice.
- Follows up with providers as needed until documentation
improves.
- Develops and coordinates educational and training programs
regarding elements of coding such as appropriate documentation,
accurate coding, coding trends found during chart reviews, third
party audit findings, and annual coding updates.
- Evaluates and provides appropriate documentation for the third
party payer CPT denials to maintain the original CPT assignment,
and when necessary, implement corrective action plan and/or
educational programs to prevent similar denials and rejections from
recurring.
- Maintains up to date knowledge of coding guidelines as they
relate to professional services.
- Serves as a resource to the office staff, providers, and coding
department.
- Provides clarification on NGPG/NGHS coding and compliance
policies.
- Meets with the Coding & Compliance Department as needed to
review the audits, discuss concerns, and make plans for
processes/procedures.
- Assists with submission of charges/claims during high volume
and/or end of month. -
- Assists, as needed, with Coding Department work queues,
deferrals, and claim edits. -
- Conducts peer to peer audits and provides education for new
Coding department employees, or as needed. -
- Audits charts to ensure the NGPG/NGHS coding staff are
utilizing the correct CPT, ICD-10, HCPCS, modifiers and other payor
requirements as necessary.
- Handles coding issues escalated from other areas of the
organization (A/R, customer service, etc.)
- Conducts RL6 research, feedback and tracking for the coding
department.
- Attends Regional and Local sponsored in-services and/or
continuing education.
- Participates in professional development activities and
maintains professional affiliations as necessary.
- Attend billing educational sessions to enhance coding knowledge
i.e. American Academy of Professional Coders, Professional Medical
Coding Curriculum, NGPG Compliance Proficiency training, specialty
seminars.
- Performs other job duties as assigned.
- Cross trains in other positions as requested. -Physical Demands
- Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
- Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
- Vision: Moderate, Frequently 31-65% of time
- Kneeling/Stooping/Bending: Occasionally 0-30%
- Standing/Walking: Occasionally 0-30%
- Pushing/Pulling: Occasionally 0-30%
- Intensity of Work: Frequently 31-65%
- Job Requires: Reading, Writing, Reasoning, Talking,
Keyboarding, DrivingWorking at NGHS means being part of something
special: a team invested in you as a person, an employee, and in
helping you reach your goals. -NGHS: Opportunities start
here.Northeast Georgia Health System is an Equal Opportunity
Employer and will not tolerate discrimination in employment on the
basis of race, color, age, sex, sexual orientation, gender identity
or expression, religion, disability, ethnicity, national origin,
marital status, protected veteran status, genetic information, or
any other legally protected classification or status.
Keywords: Northeast Georgia Health System, Inc, Atlanta , Coding Education Quality Auditor-Hybrid, Other , Oakwood, Georgia
Didn't find what you're looking for? Search again!
Loading more jobs...