Professional Coding Edu/Auditor - Yale New Haven Health

Overview:To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Professional Coding Audit Educator is an essential part of the Professional Coding Leadership Team. This role is responsible for being the department subject matter expert in professional coding and helps to support physicians, practices, coders, and coding and operational leadership. This individual is responsible for developing an educational pathway for professional coders to grow and develop in their positions to become more accurate and knowledgeable coders. This position is responsible to develop the professional coding education program, which includes supporting coders, clinicians and others within professional revenue cycle. Additionally, this individual is responsible to conduct audits to assess risk and implement any necessary action plans resulting from findings. This individual is essential to develop and maintain coding compliant controls for consistent and accurate coding with the department and to ensure optimal charge capture.

EEO/AA/Disability/VeteranResponsibilities:

• 1. Educates and provides direction to providers and coding staff on proper CPT, ICD-10 and HCPC coding. Serves as a subject matter expert on interpretation and application of professional fee and professional coding rules and regulations.
• 2. Reviews and responds to coding questions by physicians, coding staff and practice/operations leadership within a timely manner
• 3. Facilitates virtual events, calls, and training to meet coding needs and requests on charging, documentation or compliant coding.
• 4. Creates and maintains all training materials and educates providers, coders, and other coding professionals on coding related topics. This includes but is not limited to creating and rolling out coding curriculum, workflows, tip sheets, coding policies, physician communication (query) templates, etc. in conjunction with coding leadership. Delivers training using a variety of delivery methods, including and not limited to: 1:1, small -group, large group, webinar style or live education.
• 5. Tracks the efforts tied to the audit education program, including but not limited to: trainings, policies, procedures, audits and staff certifications. Communicates regularly with department leadership on status of educational initiatives, department accuracy, and opportunities for additional educational needs.
• 6. Assesses new and existing coder skillsets and develop coding training for onboarding and ongoing skill development and reports findings and recommendations to coding leadership. Develops follow up coding educational plans based on individual performance and challenges. Leads apprentice initiatives.
• 7. Conducts reviews of charging to identify opportunity for charge capture, ICD-10 specificity, denial prevention and proper coding for professional services and works with staff and others within the health system to provide feedback, guidance and education to support optimal charging and workflows. Develops action plans as needed to improve department accuracy and to share information regarding physician workflow opportunities.
• 8. Performs coding audits, when needed, as defined by compliance requirements and client expectations, determines when additional education is necessary and assists the education team in meeting those needs
• 9. Develops department audit workplan to mitigate risk and to assess areas of opportunity and implement corrective actions.

Qualifications:

EDUCATION

Bachelor's degree or currently enrolled in a bachelor's degree program required.

EXPERIENCE

Five (5)+ years of coding and/or coding audit educator work experience required. A certified AAPC Instructor credential can be substituted in lieu of 2 years of work-related experience. Expert subject matter coding knowledge, including in-depth understanding of applicable coding guidelines, payment methodology, CMS regulations and leveraging coding resources to research to answer questions. Epic experience preferred. Must have past experience with training and education in large and small groups, working with physicians and building training material and coding curriculum.

LICENSURE

Must have a CPC credential (Certified Professional Coder) through AAPC and either has or will have a coding instructor designation through the AAPC within 6 months of hire. Additional coding specialty credentials are highly desired.

SPECIAL SKILLS

Ability to work under minimal supervision and prioritize educational needs of the department with support needed by clinicians and other areas within the health system. Strong presentation skills. Must be able to develop customized coding curriculum and deliver training in a clear logical and informative manner. Subject matter expert in professional coding. Must be able to work with individuals at all levels of the health system, especially physicians and practice leadership. Must be organized and meticulous with documentation and reviews.

PHYSICAL DEMAND

Hours may vary depending on training needs.