Overview Job Description - Director, Coding Auditor & Educator (7410-2297)
LifePoint Health Support Center
Description
The Director, Coding Auditor and Educator is responsible for reviewing and auditing hospital medical records for coding completeness and accuracy. This position identifies potential coding and DRG error and researches appropriate coding guidelines to support recommended changes. This position will communicate these changes in a timely manner. This position will provide coding education and expert coding advice to the coding staff. The Director, Coding Auditor and Educator will develop education/training materials including the development of coding guidelines, policies and procedures. This individual would demonstrate proficiency in auditing principles (including re-auditing). This individual communicates with IRM, Group Leadership, Ethics and Compliance Department members, hospital HIM coding and DI regarding coding audit issues, current coding regulations and Utilization Review concerns. Stays abreast of current coding regulations, admission review requirements, professional standards Company and Department policies and procedures and effectively applies this knowledge.
Immediate Supervisor: VP, Clinical Revenue Integrity
General Responsibilities
Performs coding quality audits and special project reviews.
Review claim denials and rejections pertaining to coding and medical necessity issues and implements corrective action.
Develops coding quality audit reports (memo, executive summary, audit findings, and action plan).
Analyzes data, identifies trends/conclusions (e.g. coding practices, case-mix changes, etc.), and proposes strategies for resolution and education opportunities. Provides education support on documentation, coding, billing and utilization review management. Prepares and presents educational programs related to coding.
Stay abreast of coding and billing requirements, company/department policies and procedures to effectively apply this knowledge to complex coding quality and compliance situations.
Proactive thinking and recommends action for improving coding compliance.
Serves as a resource for department managers, staff, physicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.
Maintains an open dialogue, promotes collaboration and good working relationships with all members of the HSC and hospital teams.
Performs other department duties as assigned.
Qualifications
Associate or Bachelor degree in Health Information Management
RN with CCS, preferred.
Minimum of 3-5 years of hospital coding, including knowledge of 3M coding/grouper.
Knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing.
Proficient with Microsoft software (Word, Excel and PowerPoint).
Knowledge of Medicare and all payer reimbursement methodologies.
Knowledge of utilization management techniques.
Familiar with audit management techniques
Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the Company and the immediate supervisor.
Must work with deadlines and related time pressure.
Knowledge of statistics, data collection, analysis, and data presentation
Excellent interpersonal communication and problem –solving skills
Excellent written and oral communication skills
Travel 40% of the time.
Physical Demands/Working Conditions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Requires prolonged sitting and some bending, stooping, and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally. Work is performed in an office environment and involves frequent contact with staff and the public.
LifePoint Health, Inc. is an Equal Opportunity Employer
EOE Minorities/Females/Protected Veterans/Disabled
LifePoint Health is committed to being a place where employees want to work and takes seriously our responsibility to comply with all regulatory and legal guidelines throughout the recruitment and hiring process. The recruiting process with LifePoint Health will always include emails to job candidates from an address ending in “@lpnt.net”, as well as at least one phone interview and/or in-person interview prior to hiring.
This job description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this job description. The individual(s) may be called upon and required to follow or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.
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