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Coding Auditor-Educator is an advanced level position utilizing ICD-10-CM, ICD-10 PCS, and CPT-4 Coding Classification systems. Utilizes an encoder and computer assisted coding software to achieve accuracy and thorough coding. The Auditor-Educator researches complex coding scenarios and queries physicians on documentation for clarification. Assists with training of new staff and conducts staff quality coding reviews.
This is clinical coding position at a highly experience level as the position requires training and routine auditing. Coding Auditor-Educator analyzes clinical documentation; assign appropriate diagnosis, procedure, and, in some cases, abstract the codes and other clinical data. This information is then used to determine reimbursement levels, assess quality of care, study patterns of illness and injuries, compare healthcare data between facilities and between physicians, and meet regulatory and payer reporting requirements. Assist in the resolution of clinical documentation and charge capture discrepancies, and provide feedback to providers on the quality of their documentation.
In addition, performs pre-billing reviews of specific types of cases deemed difficult to code and prone to error, performs coding audits, and trains new coding staff, monitoring performance and providing feedback, as needed.
Coding Auditor-Educators will be required to also perform some routine coding functions when dependent on work-flow needs.
Code and abstract clinical and demographic data for inpatient, outpatient, or clinic encounters using standardized coding regulations, abstracting rules, and Fairview guidelines.
Support and assist Coding staff during back-logs.
Identify and resolve clinical documentation and charge capture data discrepancies to improve quality of the clinical documentation, severity and reimbursement levels assigned, integrity of data reported.
Utilizes technical coding principals and/or APC or MS-DRG/APR-DRG reimbursement expertise to assign appropriate ICD-10 Diagnoses/Procedures or CPT procedures and assigns modifiers to CPT codes.
Validates computer assisted coding (CAC) generated and suggested codes in conjunction with encoder. Is proficient in using various coding software tools and able to solve complex software issues along with IT experts and assists others in resolution.
Assigns present on admission (POA) value for inpatient diagnoses and identifies non-payment conditions (HAC) and ensures correct reporting.
Educates new and existing coding staff, transferring knowledge to them effectively, is a subject matter expert under the realm of coding and assists the coding coordinators with Quality audits.
Initiate post-coding pre-billing DRG review, collaborates with CDI Specialists to assign appropriate MS-DRG.
Query providers for additional documentation according to established procedures and guidelines.
Audit and educate multidisciplinary team members, including physicians, as it pertains to frequently changing mandated rules, regulations and guidelines.
Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards.
Actively participates in creating and implementing improvements.
Performs other responsibilities as needed/assigned.
Certificate program in coding, associate degree in HIM, or equivalent healthcare coding experience.
3 years experience coding all types of hospital visits/admits with a high degree of skill and expertise
One of the following required:
Registered Health Information Administrator (RHIA),
Registered Health Information Technician (RHIT)
Certified Coding Specialist (CCS)
Certified Coding Specialist-Professional (CCS-P)
Certified Professional Coder (CPC)
Certified Outpatient Coder (COC)
Associate or bachelors degree in HIM.
4+ years experience coding all types of hospital visits or admits with a high degree of skill and expertise in the specific role (IP/OP)
Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA)
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.