EMR CODING AUDITOR

EMR Coding Auditor

Summary/Objective:

The EMR Coding Auditor (ECA) facilitates improvement in the overall quality, completeness and accuracy of medical record documentation. The individual will perform medical record reviews based on CMS Quality Standards and validating active chronic problems for each patient and communicating with the physician to ensure Hierarchical Condition Coding is met, as well as accurate and up-to- date patient problem lists are documented in the EMR. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes.

The ECA reports to the Population Health Manager. It is the obligation of each Galen associate to comply with and promote the Galen mission, core values, privacy and corporate/departmental/site policies (I.E. Dress code, Time and attendance, et al).

Essential Functions:

Coordinate Patient Services

• Perform medical chart reviews to confirm adherence to AAPC clinical coding guidelines.
• Complete audits daily to validate compliance with quality standards and HCC documentation.
• Queries the provider to educate and improve individual patient documentation in the EMR.
• Protects self and other team members by following all compliance, HIPAA and infection prevention guidelines and regulations.
• Respects patients by recognizing their rights; maintaining confidentiality.
• Assist patient's primary care provider with coordination of care/services to ensure the smooth transfer of member information across the continuum of care.
• Maximize the use of resources to improve quality outcomes with reduction of unnecessary tests/procedures maintaining accurate and complete documentation in the medical record.
• Proactively engage with patients, family and/or caregivers to educate and coordinate completion of necessary procedures or tests.

Establish and Maintain Quality Care Population Health Coordination

• Independently monitors and reviews an assigned patient population.
• May provide telephonic outreach to patients identified as high risk, with chronic condition(s) to assist with medical record requests, as needed.
• Thorough understanding of ICD-10, CPT and complex co-morbidity coding.
• Participate in monthly and quarterly meetings, as requested by supervisor.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state- of-the-art practices and participating in professional organizations regarding clinical quality measures and governmental regulations.

Other Duties/Responsibilities:

• Other duties as assigned.

Knowledge/Expectations/Abilities:

• Records maintenance skills.
• Ability to communicate effectively, both orally and in writing.
• Ability to maintain calendars and schedule appointments.
• Ability to understand and follow specific instructions and procedures.
• Word processing and/or data entry skills.
• Skill in the use of operating basic office equipment.
• Ability to create, compose, and edit written materials.
• Organizing and coordination skills.
• Promote the mission, vision, and values of Galen Medical Group.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Report to work on time and as scheduled.
• Wear identification during work hours.
• Represent the organization in a positive & professional manner.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
• Comply with all organization policies and standards regarding ethical business practices.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services as directed by your manager.
• Consistently demonstrate the value of team concept.
• Ability to manage multiple and simultaneous responsibilities.
• Complete assignments efficiently and in a timely manner.
• Understands and abides by OSHA, HIPAA & CLIA standards.

Qualifications:

Education

• Must be certified as procedural coder and maintain certification throughout employment.
• Must have strong analytical, oral and written communication skills.
• Associates Degree in related field preferred.

Experience

• Minimum of two years of healthcare experience required with one-year clinical experience preferred.
• Minimum of two years of customer service experience required.

Skills/Certifications

• Excellent customer service skills.
• Exceptional skills of independence, organization, verbal and written communication, problem-solving, professional interaction, and human relation skills, as well as analytical skills and problem-solving ability.
• Must be PC literate with strong computer navigational skills, as well as extensive knowledge of Windows and Microsoft Office.
• Knowledge of basic medical terminology.
• Proficient with processes to build teams and participate in cross-functional teams.
• Ability to work within specified timeframe requirements, including timeframes for goal achievement.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patients needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.