The Coding Educator Auditor will coordinate coding audits and education functions for system coding services, managing edit and denial work queues for various settings and providing feedback for educational opportunities. This role involves reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and presenting educational programs related to coding.
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CThe Coding Educator Auditor will coordinate coding audits and education functions of LCMC system coding services. This individual will be responsible for managing and working the edit and denial coding work queues for inpatient, outpatient and ambulatory and will provide coding feedback for education opportunities identified to the coding team. Prepares and presents educational programs related to coding. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.
General duties
Reviews cases for accurate coding, monitoring the assignment and sequencing of ICD-10-CM/PCS and CPT codes to facilitate the correct assignment of diagnostic and procedure codes.
Sequences diagnoses and procedures accurately according to coding principles.
Reviews non-CC/MCC records to determine if record was miscoded or if additional documentation is needed.
Works coding edits work queues and provides feedback and coding education to coding staff regarding completeness and accuracy of code assignment.
Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.
Reviews discrepancies between Clinical Documentation Specialist (CDS) DRG and the Coder DRG.
Performs reviews in a timely manner to maintain DNFB within the assigned targeted goals.
Assist in the development and provides ICD-10-CM/PCS, CPT/HCPCS, DRG (MS & APR) and APC auditing, coding and reimbursement training.
Monitor and report the coders progress through the orientation and training processes.
Establish timelines for training completion specific to level of training necessary.
Keeps abreast of new regulatory requirements, annual revisions to the codes, etc. and applies this information appropriately.
Works as subject matter expert and provides expertise when applicable.
Performs and reports research on topics related to health information management, coding, billing and related compliance issues.
Ensures audit findings and trends are investigated and education is prepared and reviewed with coding staff when necessary.
Monitors changes in laws regulations, standards as they that affect coding, billing and related compliance.
Reads, analyzes and interprets laws, regulations, policies and procedures governing the healthcare revenue cycle.
Identifies potential areas of compliance vulnerability and risk, develops and identifies potential corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
Prepares and distributes audit results/reports for the system coding program to Coding management staff.
Works with coding Manager to improve coding services provided by coding staff.
Assist system coding leadership with training and/or development of a performance improvement track for coding staff in the disciplinary process related to quality or productivity performance.
Performs special coding –related projects as assigned.
Other duties as assigned.
EDUCATION QUALIFICATIONS • Required: Associate's Degree HIM (LCMC)
Skills and abilities
Knowledge as it relates to, but not limited to, electronic health record, health information systems and healthcare applications and their effects on Coding practices today and in the future.
High ethical standards.
Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
Experience in ICD-10-CM/PCS, auditing, coding and reimbursement training.
Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
Extensive knowledge of hospital and professional coding including provider based billing.
Knowledge of documentation regulations of Joint Commission and CMS.
Experience with concurrent coding reviews.
Knowledge of medical terminology, classifications systems and vocabularies.
Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
Experience in assisting and identifying learning needs as well as providing education and training designed to support a learning organization.
Strong analytical abilities and problem-solving skills.
Excellent oral, written and interpersonal communication skills.
Ability to organize and set priorities to ensure objectives are met in a timely manner.
Ability to adapt to change and handle challenges proactively and with pose.
Ability to effectively collaborate with physicians and managerial staff at all levels.
Work shift: Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary
Your extras
Deliver healthcare with heart.
Give people a reason to smile.
Put a little love in your work.
Be honest and real, but with compassion.
Bring some lagniappe into everything you do.
Forget one-size-fits-all, think one-of-a-kind care.
See opportunities, not problems – it’s all about perspective.
Cheerlead ideas, differences, and each other.
Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.
2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.
3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.
4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
Candidates must have a minimum of 5 years in physician and hospital coding, with 2 years specifically in coding audit experience, preferably within Cardiology. Required education is an Associate's Degree in HIM, along with specific certifications like Certified Inpatient Coder or Certified Professional Coder.