Company: Allegheny Health Network
Job Description:
GENERAL OVERVIEW:
Join our dynamic team as a Coding Auditor Instructor, where you will play a critical role in ensuring the accuracy and compliance of coding, billing, and medical documentation. You will conduct comprehensive audits on medical records relating to DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will help us optimize reimbursement strategies and improve data quality while adhering to regulatory requirements.
ESSENTIAL RESPONSIBILITIES:
Lead audits and assess the documentation, coding, and billing practices across various AHN entities. Develop and implement training programs tailored to address deficiencies discovered during audits, ensuring compliance with regulatory standards. Work closely with management on external audit findings and participate in strategic discussions to resolve issues. (20%)
Create detailed audit reports to highlight coding, documentation, and financial impacts. Facilitate educational sessions or collaborate with external professionals to present findings comprehensively to staff and physicians. (20%)
Diligently validate coding systems (ICD-CM, ICD-PCS, CPT, and HCPCS Level II), ensuring accuracy and compliance with DRG/APC structures. Perform regular claim form reviews to guarantee precise code transfer from abstracting systems. (10%)
Oversee the creation and monitoring of inpatient case mix reports to identify patterns in DRG/APC assignments. Evaluate identified issues and implement appropriate strategies for resolution. (10%)
Analyze medical information to accurately classify it into payor-specific groups through coding for diagnoses and procedures. (10%)
Adhere to the Standards of Ethical Coding as established by the American Health Information Management Association and Corporate Compliance Coding Guidelines. (10%)
Engage in additional assigned duties, such as mentoring new staff and assisting with special project audits. (10%)
Coordinate or facilitate training for healthcare professionals on coding guidelines, documentation techniques, and clinical data quality management. Design and implement ongoing coder education programs. (10%)
Other duties as assigned.
QUALIFICATIONS:
Minimum:
High school diploma/GED
Certification from AAPC or AHIMA
AHIMA Credentials (Inpatient or Outpatient): RHIT, CCS
AAPC Credentials (Outpatient): CPC, COC, CPMA
5 years of experience in hospital or physician coding/auditing and educational methods (3 years for internal transfer candidates)
In-depth knowledge of coding systems (ICD CM, ICD PCS, CPT/HCPCS) and DRG/APC structures.
Strong analytical and communication skills.
Preferred:
Associate's Degree
3 years of experience in claims processing and data management
Prior auditing and education/training experience in coding and reimbursement
Disclaimer: This job description provides a general overview of the nature and essential duties associated with this position. It may not encompass all tasks, responsibilities, and qualifications required.
Compliance Requirement: This position adheres to ethical and legal standards as outlined in the business conduct code and company policies. Employees may have access to confidential information that must be protected at all times in compliance with HIPAA and other relevant regulations.
Pay Range Minimum: $27.36
Pay Range Maximum: $44.13
Base pay depends on various factors, including qualifications, experience, and internal equity.
Highmark Health and its affiliates are committed to prohibiting discrimination in every form. We strive to maintain an inclusive environment for all employees.
For accommodation requests, please contact HR Services Online.
Req ID: J277789