Outpatient Coding Auditor

Outpatient Coding Auditor

Responsible for implementing and maintaining a compliance plan for outpatient coding and reimbursement. The Outpatient Coding auditor will assist the Coding Manager with Outpatient and Emergency Coding Services, and the development of policies and procedures.

Develops education and supervises programs regarding elements of the HIM Compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff, physicians, billing personnel and ancillary departments.

Coordinates and conducts continual reviews, tracking and trending following the outpatient coding audits. Educates new outpatient coders on documentation requirements including how to read an outpatient medical record and extrapolate the required documentation with regards to outpatient surgery coding. Educate outpatient coders on ICD-10-CM guidelines, coding conventions and Coding Clinics pertinent to outpatient surgery coding.

Educate outpatient coders on CPT/HCPCS guidelines, coding conventions and CPT Assistant pertinent to outpatient surgery coding. Educate outpatient coders with regards to pertinent coding policies and procedures. Conduct quality review of coding to assure accurate codes, APC assignment, and accurate reimbursement. Summarize quality monitoring results to support performance appraisals and process improvement activities.

Research and respond to outpatient coding questions. Work the daily unbilled report to ensure timely coding. Review quality audit results with individual associate and conduct follow up review to assure resolution. Act as liaison with PFS department to resolve all outpatient coding review requests.

Minimum qualifications:

Certified Coding Specialist (CCS) certification required. Minimum 4 years’ experience with coding ICD-10 in an acute care setting with 2 years of experience in performing APC coding audits. Possesses knowledge of APC and grouping methodologies; in particular what diagnoses / procedures APC assignment.

Must have basic computer skills in word processing and spreadsheet utilization. Must have excellent interpersonal skills to develop relationships necessary to facilitate and educate, and excellent prioritization and organizational skills.

Physical requirements (medium): 20-50 lbs; 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 50 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. Environmental factors: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at View email address on click.appcast.io. Please note that one week's advance notice is preferred.