Coding Auditor
Company: Wellstar Health System, Inc.
Location: Atlanta
Posted on: April 16, 2024
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Job Description:
Facility: VIRTUAL-GA
Job Summary:
Under direction of the Manager of Coding Assurance/Compliance,
reviews chart documentation to ensure coders have appropriate
coding and DRG assignment, discharge disposition, admit and
discharge dates and reimbursement. Educate staff when errors are
identified. Coordinates payment corrections with the assistance of
the Billing and Revenue Cycle team:
Audit hospital and/or physician medical records and charges to
ensure compliance with coding and regulatory standards.
Conduct medical record reviews to ensure accurate, ethical
documentation, coding, charging and billing practices.
Support and provide coding and compliance training to coding staff,
physicians, clinical personnel, billing, and/or other hospital
staff.
Establish effective communication with coding staff, physicians,
clinical staff, and/or hospital staff to address documentation,
coding, and reimbursement issues.
Educate coding staff, physicians, clinical staff, and/or hospital
staff on appropriate documentation as required by medical review
and governmental agencies.
Develop written policies promoting WellStar's commitment to
compliance and specific areas of potential fraud and abuse.
Use knowledge of coding and compliance guidelines to identify
potential billing / reimbursement issues.
Participate in special audits as instructed.
Work as a team member within Coding Assurance and all other
departments.
Ability to work remotely and independently with self-driven focus
on job completion.
Document work processes as required.
Perform other duties as assigned.
Core Responsibilities and Essential Functions:
DRG Validation, RAC and Government Entity Reviews, Appeals,
Overpayment Review Functions Investigate overpayment and
underpayment issues through DRG reviews, responses to RAC and other
governmental audit requests, internally generated audit requests,
Epic Work Queue assignments:
- Conduct data sampling, auditing, and reporting on all reviews
associated with the Annual IP Coding Assurance Audit plan and as
otherwise directed to the level of detail required;
- Participate in Epic Work Queue assignments as necessary to ensure
compliance with governmental and internal regulations;
- Research official guidelines to plan scope of focused
reviews;
- Participate and lead audits with focus on inpatient hospital
ICD9-CM, ICD-10-CM / PCS, some CPT4 coding as well as National and
Local Coverage Determinations, OIG Work plan, and any other
federal/state regulations;
- Communicate trends and audit findings with the respective
hospital departments and educate as appropriate;
- Prepare Findings and Executive Summary reports to distribute to
coding and compliance leadership
- Prepare and distribute audit findings worksheets to coders;
- Engage in cooperative education with the coders when discussing
audit findings;
- Assist in data warehousing, data reporting, and data integrity
tasks of audit data housed in Compliance db's and spreadsheets;
- Direct resubmission of claims and help prepare disclosures as
necessary. Benchmark comparisons and identification of trends and
errors in coded data
- Review data analytics;
- Identify / track trends and errors to identify overpayments or
revenue enhancement opportunities;
- Trend and analyze denials, provide feedback and education to all
entities ;
- Identify, find solution, communicate solution with both external
and internal customers as required utilizing Findings and Executive
Summary formats;
- Distribution and analysis of reports to relevant, affected
departments;
- Provide and participate in error resolution to correct variances
in coding and/or charge practices;
- Assist with the implementation of new processes as needed to
assure error resolution. Provide education and support
- Review CMS regulations and official coding guidance to stay
abreast of coding/billing regulatory changes;
- Summarize National/Local Coverage Determinations;
- Presentations (Develop and present coding/compliance education
material);
- Provide denial/appeal follow-up;
- Provide post review follow-up education with WellStar employees,
management and physicians;
- Provide education on new releases from Medicare and Medicaid;
- Answer compliance/documentation/coding/billing questions via
e-mail.
Required Minimum Education:
Bachelor or Associate-level degree in Health Information
Management, Business, or other health care related field preferred
(years' experience may be considered in lieu of same).
Preferred
Required Minimum License(s) and Certification(s):
Reg Health Information Admin 1.00 Upon Hire Required
Reg Health Information Tech 1.00 Upon Hire Required
Cert Coding Spec 1.00 Upon Hire Required
Cert Prof Coder - Hospital OP 1.00 Upon Hire Required
Additional Licenses and Certifications:
Required Minimum Experience:
Minimum 5 years inpatient coding experience required with one to
two years of hospital-based outpatient services coding experience
and one-year inpatient coding audit experience preferred Preferred
and
A combination of 5 years of comparable experience with hospital
coding, billing and reimbursement experience may be substituted for
an Associate's degree. Required
Required Minimum Skills:
Excellent communication, organization, and educational skills.
Extensive knowledge of medical terminology, ICD-10-CM and
ICD-10-PCS coding (as well as ICD-9-CM), CPT-4 procedural coding
(including Level II HCPCS), and all coding and billing
guidelines.
Hospital billing experience with focus on government payors.
Extensive experience with (electronic) medical record chart review
and/or extraction, hospital billing.
Extensive experience with Medicare, Medicaid, and reimbursement
rules and regulations.
Experience with management information systems and medical
software.
Competence in Microsoft Word and Excel software in a Windows
environment (Experience with Microsoft Access Is a plus).
Keywords: Wellstar Health System, Inc., Sandy Springs , Coding Auditor, Accounting, Auditing , Atlanta, Georgia
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