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Coding Compliance Educator

OSS Health
Job Description
Oversees the HIM coding compliance program - Coding, Auditing and Query Processes. This position is responsible for DRG validation accuracy, auditing of inpatient and outpatient surgery records, evaluation and management (E/M) visit/procedures to ensure coding accuracy and provide on-going feedback and continuing education to coders and clinicians. Maintains statistics on Query, DRG, surgical and E/M documentation and coding accuracy rates for the organization and continually monitors progress, as well as being available as a resource. Works with external auditing companies engaged with OSS Health.

Requirements and Responsibilities:
  • High school diploma or GED required; Associate’s degree in relevant field preferred.
  • Minimum of 3 years of recent experience coding, including but not limited to acute care hospital inpatient, outpatient, surgical and professional fee (Evaluation & Management). 
  • Minimum of 3 years of experience in coding compliance audit work highly preferred. 
  • CPMA, CCS, CPC and/or CCP certification required. 
  • Member in good standing with AHIMA and/or AAPC.
  • Must have knowledge of Medical Terminology, Anatomy and Physiology, ICD9/10, CPT, Coding guidelines and methodologies, DRG, APC, NCCI, LCD, NCD.
  • Excellent computer skills required, to include Microsoft Excel and Powerpoint.  Experience with Electronic Record Systems required; experience with Medent or CPSI preferred.
  • Must possess excellent communication and interpersonal skills.  Must be able to work in a virtual setting under minimal supervision.
  • Must have the ability to maintain composure and professionalism in difficult situations.
  • Must have excellent phone etiquette and be able to operate basic office equipment (copiers, fax, etc.).
  • 3M coding software products or other encoder product experience required.
  • Complies with all policies and procedures.
  • Consistently and accurately audits complex coding records for inpatient and outpatient – hospital and professional.
  • Creates clear and concise audit reports.  Reports non-compliance issues detected through auditing and monitoring.
  • Establishes, implements, and maintains a formalized review process that incorporates regular audits (provider, coding, charge posting and documentation adequacy) and coordinates ongoing monitoring with education to provider, coders and charge posters.
  • Conducts trend analyses to identify patterns, variations in coding practices and case-mix index, including areas of risk and comparing coding profiles with national and regional norms.
  • Develops and coordinates educational and training programs regarding elements of the HIM compliance program, such as appropriate documentation, accurate coding, data compatibility, consistency and monitoring for compliance to improve the quality of clinical, financial and administrative data supported.
  • Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff to both individual and group (as evidenced  by the improvement accuracy rates).     
  • Initiates corrective action plans and reports results of follow-up audits to HIM Director and Coding Manager.
  • Maintains statistics on DRG accuracy rates and provides monthly summaries of coding audit results
  • Acts as a resource on coding issues and questions to ensure accurate coding for appropriate reimbursement and data capture for inpatient and outpatient review or potential appeals.
  • Demonstrates up-to-date knowledge of healthcare regulatory billing issues, coding mandates, and reimbursement rules and guidelines, OIG work plan.
  • Analyze audits and RAC findings.
  • Produces documents of the highest professional quality: clear, concise and error free; prepared with correct medical terminology and correct use of the English language.
  • Maintains records of logs, files, education, presentations, etc. concerning all external physician and coder/charge poster audits.
  • Performs other duties as assigned.
Contact Information