PPG Auditor/Educator

Job Summary Audits medical record documentation and coding to extract data and determine appropriate ICD-10-CM/PCS and HCPCS codes for billing, internal and external reporting, and compliance with the Official Coding Guidelines for Coding and Reporting, payer regulations, and Clinic/hospital policy. Educates physicians and clinical personnel to ensure complete documentation in the medical record and queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices. Educates and trains coders to ensure both a working knowledge of coding and reimbursement guidelines and successful career ladder completion, including the development of training materials and reference documents. Researches audit results, error reports, and denials and resolves by successful appeal, staff education, and correction of discrepancies. Serves in an educational and advisory capacity to the coding staff, clinical staff, and physicians as it relates to documentation, coding, and regulatory compliance. The CBO coding Auditor/Educator reports to the CBO Coding Manager.

Qualifications 2 year / Associate's Degree in related field; In leu of Associates Degree, eight (8) years directly related experience (Required)

Work Experience

4 years Experience with ICD-10, CPT, and HCPCS coding (Required)

4 years Extensive knowledge of medical terminology (Required)

4 years of related Revenue Cycle healthcare experience, preferably within coding and billing (Preferred)

3 years of experience in health information management or coding management in a physician practice/clinic setting (Preferred)

Prior Athena Or Meditech Experience. (Preferred) Experience with any of Phoebe Provider Group’s legacy financial systems (Preferred)

Licenses and Certifications

Required Certifications/Licensures CPMA, Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), or Certified Professional Coder (CPC)

Essential Functions Additional Duties

Adheres to the hospital and departmental attendance and punctuality guidelines.

Performs all job responsibilities in alignment with the core values, mission and vision of the organization.

Performs other duties as required and completes all job functions as per departmental policies and procedures.

Maintains current Knowledge in present areas of responsibility to include any specialty certification requirements (i.e., self-education, attends ongoing educational programs).

Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.

Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs. For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.

Wears protective clothing and equipment as appropriate.