Coding Auditor Education Specialist - Ambulatory

Position Details

Department: CORP | Professional Svcs Coding
Category: Hlth Info Mgmt/Med Records
Location: Telecommuting
Employee Type: Regular
Posting #: 696312
Posted On: 9/15/2022

Position Summary

Under direct supervision of the Manager of Professional Services, performs functions as both coding auditor and educator and is responsible for providing oversight on education and audits of medical records for compliance with federal coding regulation and guidelines. This position is responsible for the coordination of auditing and education in support of achieving organizational strategic initiatives. The position has a shared responsibility to assist in achieving teams goals. Uses knowledge of PCH policies and procedures to provide a second level review of all Codes (CPT, EM, ICD-10 etc.) to achieve and maintain compatibility with Government and PCH billing requirements and compliance standards. This position also assists with coding production as needed; reviews and resolves coding issues related to billing, researches complex coding issues, and participates in process improvements related to coding and EM management.

Position Duties

  1. Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
    • Ensures compliance with Federal Coding Documentation Guidelines and PCH/PCMG official coding policies.
    • Audits medical record documentation of Ambulatory services to verify the accuracy and specificity of all assigned codes, modifiers, POS, units, etc.
    • Provides documentation/coding education to coders and providers to maximize accuracy, completeness and compliance with accepted standard of practice and current coding guidelines.
    • Maintains current department policies related to coding and documentation requirements.
    • Collaborates with other disciplines and departments as a change agent and participated in the evaluation of outcomes.
    • Researches and resolves complex coding/documentation issues.
  2. Performs internal coding and documentation quality reviews of coded Ambulatory services and professional fee assignment of medical records to verify the accuracy and specificity of assigned codes in accordance with documentation guidelines.
  3. Educates Communicates with providers and coders regarding medical record documentation in order to maximize accuracy, completeness, and compliance with accepted standards of practice and current coding guidelines.
  4. Reviews accounts, when requested by the Physician Billing and Revenue Cycle Department and other clinical departments to research and resolve coding issues related to billing.
  5. Participates in continuing education activities to maintain current credentials, as well as to enhance knowledge and skills.
  6. Reviews Medical records for appropriate Diagnosis/EM/CPT/HCPCS codes and modifiers in compliance with Official Documentation Guidelines for Coding and Reporting as well as PCMG coding policies.
  7. Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Education
Do you meet this requirement?
1. High School Diploma or equivalent.
Required
2. Associates/Bachelor degree in Health care related field
Preferred
Experience
Do you meet this requirement?
1. Three or more years of experience in a hospital or professional entity
Required
2. One year of Physician E/M Auditing experience.
Required
3. Comprehensive knowledge of ICD-10-CM Official Guidelines for Coding Reporting, ICD and CPT/HCPCS coding classification systems, including facility and physician E/M, and hospital coding and reimbursement software.
Required
4. Experience in developing training documentation and delivering training to individuals and groups.
Required
5. Previous experience interacting with external/internal coding staff, auditors and leadership.
Preferred
Certifications / Licenses / Registries
Do you meet this requirement?
1. CPC, CCS-P, CCS or RHIT or other accredited Coding credentials through AAPC or AHIMA
Required
2. CPMA or other accredited Auditing certification through and accredited source such as the AAPC or AHIMIA
Preferred
Special Skills
Do you meet this requirement?
1. Medical Terminology and an understanding for the laws and regulations associated with medical records functions
Required
2. Previous work with Auditing software
Preferred
3. Versed in regulatory requirements for medical record documentation, as well as Medical staff Rules and Regulations where applicable
Preferred
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing - Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) - Frequently
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Constantly
4. Physical Requirement - Hearing - Constantly
5. Physical Requirement - Pushing/pulling - Occasionally
6. Physical Requirement - Reaching - Occasionally
7. Physical Requirement - Sitting - Constantly
8. Physical Requirement - Standing - Occasionally
9. Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally
10. Physical Requirement - Talking - Frequently
11. Physical Requirement - Walking - Frequently
12. Physical Requirement - Near Vision - Constantly
13. Physical Requirement - Far Vision - Constantly
14. Physical Requirement - Color Discrimination - Occasionally
15. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Occasionally
16. Physical Requirement - Lift up to 35 pounds without assistance - Occasionally
17. Occupational Exposure/Risk Potential - Inside office environment - Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply