Professional Coding Auditor-Educator

Responsible for educating and training WVU Healthcare Coding Staff as directed by Coding Managers, and for overseeing or performing overall auditing and education plans for the Coding staff. The role includes conducting coding quality audits, providing ongoing feedback and education, and utilizing coding classifications such as ICD-10-CM, ICD-10-PCS, CPT, MS-DRG, HCC, and APR-DRG to ensure accurate coding and assignment.

Minimum Qualifications

• Graduate of a Health Information Technology (HIT) or equivalent program AND five (5) years of coding experience.
• OR Graduate of a Medical Coding Certification Program AND five (5) years of coding experience.
• OR High School Diploma or Equivalent AND eight (8) years of coding experience.
• Certification in one of the following: Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) through the American Health Information Management Association; Certified Outpatient Coder (COC) through the American Academy of Professional Coders; Certified Coding Specialist (CCS) through the American Health Information Management Association; or Certified Professional Coder (CPC) through the American Academy of Professional Coders.

Preferred Qualifications

• Bachelor’s degree in Health Information Management or related field.
• Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, and MS-DRG, HCC and APR-DRG assignment for positions and multi‑specialty coding, E&M coding, procedural/surgical coding, and knowledge of governmental billing and coding regulations.
• Previous supervisory or project management experience.

Core Duties and Responsibilities

• Manages activities of designated coding personnel in training for WVU Healthcare and assures monitoring and reporting of their developmental activity.
• Manages quality improvement audits and training of designated coding staff.
• Acts as an expert coding resource for coders, clinical documentation improvement, providers, revenue cycle, specialty groups, and meetings.
• Serves as super‑user for all coding‑related electronic medical record systems, updates policies and procedures, and conducts in‑service training on changes.
• Develops and maintains coding‑related policies, procedures, query development, work queues, and training materials in conjunction with management.
• Communicates continuously with coding staff, medical staff, physician advisors, department chairs, and administrators.
• Organizes, facilitates, tracks, trends, and reports on internal quality reviews.
• Designs and uses audit tools (e.g., ROC) to monitor coding accuracy, documentation gaps, and billing performed by coding specialists.
• Coordinates audits performed by outside agencies, acts as liaison, facilitates exit conferences, and provides final reports to the coding manager.
• Coordinates coding/documentation denial reviews and facilitates appeal letter formation.
• Ensures audit recommendations (including coding education, coding changes, rebills) are completed.
• Extracts and analyzes data from various sources, developing action plans when necessary.
• Assists with onboarding of new coding specialists regarding policies, audits, and initiatives.
• Updates coding specialists on compliance and regulatory changes.
• Keeps abreast of coding changes, state and federal regulations, and coding resources (e.g., Coding Clinic).
• May be responsible for development and design of the curriculum for the WVU Healthcare Coding Certificate Program and related projects to enhance coding governance.

Physical Requirements

• Ability to sit for long periods of time.
• Visual and hearing acuity within the normal range.
• Manual dexterity to operate computer and office equipment.
• Ability to lift, push or pull 10–20 pounds.

Working Environment

• Standard office environment.
• Visual strain may occur from viewing computer screens and other written material.
• Occasional travel may be required.

Skills and Abilities

• Excellent written and verbal communication skills and interpersonal skills for effective communication.
• Knowledge of provider healthcare compliance, revenue cycle operations, and auditing techniques.
• Ability to mentor, educate, and train others.
• Ensures quality and productivity standards.
• Handles high stress and critical situations calmly and professionally.
• Maintains concentration and accuracy during interruptions.
• Independent decision‑making ability.
• Prioritizes job duties effectively.
• Adapts to changes in workplace and assignments.
• Organizational and time‑management skills.
• Knowledge of anatomy, physiology, and medical terminology.
• Analytical and problem‑solving skills.
• Proficient in office software programs, including medical record and billing systems.
• Ability to analyze complex data and reports.

Additional Job Description

• Scheduled weekly hours: 40
• Exempt/Non‑Exempt: Exempt
• Shift: United States of America (Exempt)
• Company: SYSTEM West Virginia University Health System
• Cost Center: 539 SYSTEM HIM Provider Based Coding Analysis