Medical Coding Auditor/Educator

Medical Coding Auditor/Educator

Medical Coding Auditor/Educator
Location: CA-Los Angeles
Req #: 739
# of openings: 1


Description

Altegra Health leads the U.S. healthcare industry with business & technology solutions that improve health plan performance by aligning member health status, benefits & accurate reimbursement in the following areas:


Risk Adjustment Reimbursement & Advisory Services

Eligibility & Enrollment Quality Performance


In an age where attention to detail counts--providers, health plans & healthcare facilities trust our 1,100+ employees for comprehensive solutions that add value to their bottom line.

www.AltegraHealth.com



Job Title:Medical Coding Auditor/Educator



This full-time contract position will be based in Los Angeles, and will report to our Staffing Department of our Reimbursement and Advisory Services Division of Altegra Health. The Coding Auditor/Educator will have the following responsibilities:

Actively involved in mentoring & training all functions & services related to hospital medical coding, medical documentation, & physician queries, abstracting & data collection. Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS), Medical Severity Diagnosis-Related Groups (MS-DRG), National Correct Coding Initiative Edits (NCCI), ICD-9-CM Official Guidelines for Coding and Reporting, and Coding Clinic. Must be able to work in a Labor-Management Partnership environment. Works with Coding Supervisors & HIM Director to develop, implement, evaluate & improve coders participating in the HIM Department On-the-Job Training (OJT) Program.

Coordinates, monitors, and audits all lines of hospital business for coding, to include: all outpatient, inpatient, HOV, ED and Ambulatory surgery cases. Monitors the accuracy and quality of coding assignments, Present on Admission (POA) indicators and conducts internal coding audits. Responsible for being the regional coding contact person for the HIM department to work with Clinical Documentation Specialists to support education and coding requirements. Develops reports of audit results to Regional and facility staff and Senior Management. Helps set the direction for coding and compliance education and focused projects related to the EHR. Provide oversight and training for “Coding Compliance Software” to the coding staff. Run audit selection lists and reports as well as providing education, feedback and guidance based upon data mining activities and processes.

May provide insight into planning, directing and monitoring of Charge Capture Initiatives for Facility and Professional Charges as well as in-patient medical records(for Coding Review Manager) including: CMS, Fiscal Intermediary, Commercial and Self-Funded billing guidelines retrieval, assembly, delivery, abstracting/analyzing, coding, completion, transcriptions, release of information, and vital statistics registration. May provide (limited) oversight of the accuracy of MIRCal data for OSHPD reporting. Collaborates with the HIM Director/Manager relating to coding accuracy and coding functions within the department to assure timely and accurate completion of work that is consistent with regulatory agency requirements.

Prepares statistical and or annual coding accuracy reports as requested by state or federal agencies or any other regulatory agency under the direction of their Manager. Ensures compliance with federal, state and local regulations.

May assist in regional and facility budgets as requested and identifies and recommends opportunities to decrease costs and improve service. Functions as a liaison for other departments regarding coding questions/issues. Implements changes resulting from internal or external audits which impact collection and reporting of medical records. Participates in Regional HIM staff meeting and process improvement initiatives.

NOTE: Light travel between local Medical Center facilities is required

Requirements:

· Minimum of 4+ years of Acute Care: Inpatient, Outpatient, MS-DRG, HCC and APC coding required.
· 4+ years supervisory experience in a Medical Records department
· In-depth understanding of all state/federal regulations and CMRI, NCQA, JCAHO, and CMS.
· Demonstrated strong interpersonal communication skills.
· Ability to develop and provide high quality in-service and seminar of coding and coding related topics.
· Working knowledge of State/Federal, CMRI, NCQA, JCAHO, and CMS Regulations.
· AHIMA CCS credential mandatory, may possess an RHIT or RHIA credential in addition to the CCS credential


Altegra Health is committed to building a highly diverse, best-in-class workforce at all levels of the organization. We strive to attract and retain exceptional individuals regardless of their sex, race, color, religion, national origin, age, disability, marital status, sexual orientation, veteran status or other characteristic unrelated to the skills and abilities required for job performance.