Coding Education Quality Auditor
Northeast Georgia Health System, Inc.

Work Shift/Schedule:
Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Coding Education & Quality Auditors (CEQA) conduct coding/billing/documentation audits of all NGPG/NGHS Providers to determine organizational integrity of coding/billing for professional services, including detection and correction of documentation, coding and billing errors. Audits consist of evaluation of the adequacy and accuracy of documentation to support services billed including ICD-9/ICD10/CPT/HCSPCS and other third-party payer codes. CEQAs ensure the medical necessity of services, compliance with other documentation, coding and billing standards. CEQAs apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and standardized audit findings methodology to report audit results. CEQAs communicate audit results to physicians, physician leadership, senior management, Compliance department and staff. CEQAs are required to provide physician and coder education, and make recommendations to management for corrective action. CEQAs serve as an institutional subject matters expert and resource on interpretation and application of documentation and coding rules and regulations. CEQAs assure the quality of the coding documentation fits service and codes, and any missing labels on documentation are corrected.

Minimum Job Qualifications

• Licensure or other certifications: CPC and/or CCS-P Coding Certification. CPMA, CEMC or other Nationally recognized healthcare auditing certification required at hire, or required to obtain within 6 months of hire.
  
• Educational Requirements: High School Diploma or GED.
  
• Minimum Experience: Minimum three (3) years experience coding and/or auditing Multi-Specialty records required; Medical Terminology or Anatomy course required. Demonstrated experience in conducting education to providers and large audiences required.
  
• Other:
  

Preferred Job Qualifications

• Preferred Licensure or other certifications:
  
• Preferred Educational Requirements:
  
• Preferred Experience:
  
• Other:
  

Job Specific and Unique Knowledge, Skills and Abilities

• Detailed knowledge of ICD-9, ICD-10, CPT and HCPCS coding principles and medical terminology
  
• In-depth knowledge of best practice coding policy and procedures
  
• Highly skilled proficiency with Microsoft Office products, advanced proficiency in Excel and Powerpoint
  
• Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences
  
• Ability to organize data and provide detailed reporting
  
• Ability to prepare presentations and present to large or small audiences
  
• Must be highly motivated, organized, and a detail oriented individual
  
• Excellent communication (written, verbal and presentation) and people-facing skills
  
• Strong analytical and interpersonal skills
  
• Ability to be a self starter/work independently and as a team player
  
• Ability to travel to NGHS/NGPG sites on a regular bases
  
• Understanding of current regulatory and third party requirements
  
• Accuracy and attention to detail required
  
• Establishes and maintains positive peer, leadership and customer relationships, interacting positively and productively with teams across organizational lines.
  
• Positive work ethic with proactive and team oriented style
  
• Must posses a confident, friendly demeanor
  
  

Essential Tasks and Responsibilities

• Coordinates, schedules, performs the professional services documentation and coding audits of outpatient records for NGPG/NGHS.
  
• Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported.
  
• Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines.
  
• Audits every charge for new providers, PRN providers, locum providers, and any under compliance audit daily, till said provider passed an audit.
  
• Meets with the providers to review the audit findings and to recommend ways to improve when indicated.
  
• Orients and trains new providers throughout the year.
  
• Audit charts for accurate and correct coding and compliance within documentation guidelines and NGPG/NGHS policies.
  
• Prepares written reports of the audit findings by provider/practice.
  
• Follows up with providers as needed until documentation improves.
  
• Develops and coordinates educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates.
  
• Evaluates and provides appropriate documentation for the third party payer CPT denials to maintain the original CPT assignment, and when necessary, implement corrective action plan and/or educational programs to prevent similar denials and rejections from recurring.
  
• Maintains up to date knowledge of coding guidelines as they relate to professional services.
  
• Serves as a resource to the office staff, providers, and coding department.
  
• Provides clarification on NGPG/NGHS coding and compliance policies.
  
• Meets with the Coding & Compliance Department as needed to review the audits, discuss concerns, and make plans for processes/procedures.
  
• Assists with submission of charges/claims during high volume and/or end of month.
  
• Assists, as needed, with Coding Department work queues, deferrals, and claim edits.
  
• Conducts peer to peer audits and provides education for new Coding department employees, or as needed.
  
• Audits charts to ensure the NGPG/NGHS coding staff are utilizing the correct CPT, ICD-10, HCPCS, modifiers and other payor requirements as necessary.
  
• Handles coding issues escalated from other areas of the organization (A/R, customer service, etc.)
  
• Conducts RL6 research, feedback and tracking for the coding department.
  
• Attends Regional and Local sponsored in-services and/or continuing education.
  
• Participates in professional development activities and maintains professional affiliations as necessary.
  
• Attend billing educational sessions to enhance coding knowledge i.e. American Academy of Professional Coders, Professional Medical Coding Curriculum, NGPG Compliance Proficiency training, specialty seminars.
  
• Performs other job duties as assigned.
  
• Cross trains in other positions as requested.
  
  

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
  
• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
  
• Vision: Moderate, Frequently 31-65% of time
  
• Kneeling/Stooping/Bending: Occasionally 0-30%
  
• Standing/Walking: Occasionally 0-30%
  
• Pushing/Pulling: Occasionally 0-30%
  
• Intensity of Work: Frequently 31-65%
  
• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving
  

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

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