PFS Coding Quality Auditor Educator - Women's Healthcare Associates, LLC

The Coding Quality Auditor Educator is responsible for auditing electronic health records to review documentation and determine whether it substantiates the codes assigned (ICD-10CM/ MS-DRG/HCC). This role will be actively engaged with provider coding and billing education including coding accuracy and documentation improvement. Assist in turning audit findings into a meaningful training program for all providers and staff. Acts a coding expert resource and provides clarification on coding and compliance policies.

· Audits medical record documentation to identify under-coded and up-coded services. Prepares reports of findings and meets with coders and leadership to provide education and training on accurate coding practices and compliance issues both for coders currently in training and ongoing audits for all coders.

· Responsible for providing feedback on the application of coding guidelines, practices, and proper documentation techniques, data quality improvements, and revenue enhancements.

· Performs retrospective and concurrent audits based on coding guidelines to ensure coding accuracy and proper reporting.

· Prepares and presents reports for pre-bill and retrospective coding audits directly to audited providers and coders.

· Recommends process improvement through identification of provider or coder trends (documentation and coding) as well as workflow evaluations.

· Assists in the development of programs and procedures to support improvement of coding accuracy.

· Supports the billing team by acting as subject matter expert on coding questions.

· Interacts with providers and coding staff to resolve documentation or coding issues.

· Responds to coding questions from assigned coders/providers and provides official coding references and guidelines.

· Maintains current knowledge of coding principles and guidelines as coding conventions are updated. Monitors and analyzes current industry trends and issues for potential organizational impact.

· Reports any compliance and/or risk issues to the compliance department. Provides suggestions on process improvement.

· Serves as backup coder to the coding team for unexpected staff shortages and planned PTO.

· Assists in developing and implementing coding education for all new hire providers. Works with Compliance to ensure timely baseline audits and re-audits, providing necessary identified educational sessions.

· Collaborates with data analysts in evaluating denial reports.

· Participates in committees and meetings as it pertains to coding, billing, and documentation.

· Prepares written reports of the audit findings by provider/practice.

· Collaborates with denials management team.

· Provides clarification on coding and compliance policies.

· Associate degree in healthcare, business, or related field plus five years of production coding experience OR equivalent combination of education and experience.

· Certification as a Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) required.