Coding Auditor Educator

Allegheny Health Network; Pennsylvania; On-site; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a Coding Auditor Educator to enhance coding accuracy and compliance. This role involves conducting audits, analyzing data, and providing training to healthcare professionals. You will play a key role in ensuring adherence to coding standards and improving documentation practices. The ideal candidate will have extensive experience in coding and auditing, along with strong analytical and communication skills. Join a team committed to excellence in healthcare coding and make a significant impact on the organization’s operations and compliance efforts.

Qualifications

• 5+ years of experience in hospital or physician coding and auditing.
• Deep knowledge of coding standards and billing processes.
• Strong analytical skills for data review and compliance.

Responsibilities

• Conducts audits and reports on documentation and coding accuracy.
• Creates detailed audit reports and presents findings.
• Ensures compliance with coding standards and regulations.

Skills

ICD-CM

ICD-PCS

CPT

HCPCS Level II

Data Analysis

Communication Skills

Auditing

Education

High School Diploma / GED

Certification from AAPC or AHIMA

Associate’s Degree

Tools

Coding Software

Job description

Join to apply for the Coding Auditor Educator role at Allegheny Health Network.

GENERAL OVERVIEW

Performs all related internal, concurrent, prospective, and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing, and documentation related to DRGs, APCs, CPTs, HCPCS Level II codes, and modifiers, as well as ICD diagnosis and procedure coding. Reports findings verbally and in writing, communicating results to affected areas. Uses this information to generate topics for education, training, process changes, risk reduction, and reimbursement optimization with new and current coders, in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation supporting compliant coding. Interacts with external consultants regarding billing, coding, and documentation, evaluating their recommendations and teaching plans per federal and state regulations.

KEY RESPONSIBILITIES

1. Audit and Reporting (20%): Plans and conducts audits; reports on documentation, coding, and billing at AHN entities. Develops and delivers training to address deficiencies, provides audit guidance, and participates with management in external audit assessments. Provides guidance on external coding audits and manages appeal actions.
2. Data Analysis and Education (20%): Creates audit detail spreadsheets and reports on coding, documentation, and financial impacts. Presents audit findings and conducts training or works with external resources.
3. Code Validation (10%): Validates ICD-CM, ICD-PCS, CPT, and HCPCS Level II codes, ensuring compliance and accuracy. Performs periodic claim form reviews.
4. Case Mix Monitoring (10%): Monitors inpatient case mix reports and top DRG/APC groups, analyzing patterns and trends, and takes corrective actions as needed.
5. Medical Information Review (10%): Reviews and classifies medical information into payor-specific groups, calculating DRG and APC.
6. Compliance (10%): Ensures adherence to the Standards of Ethical Coding, AHIMA, and regulatory guidelines.
7. Additional Duties (10%): Includes training/mentoring staff, audits, research, and providing coverage for management. Arranges or provides education for healthcare professionals on coding and documentation practices.

QUALIFICATIONS

Minimum

• High school diploma / GED
• Certification from AAPC or AHIMA (e.g., RHIT, CCS, CPC, COC, CPMA)
• At least 5 years’ experience in hospital or physician coding and/or auditing; 3 years for internal transfer candidates
• Deep knowledge of ICD-CM, ICD-PCS, CPT/HCPCS, DRG/APC structure, and related software
• Strong analytical and communication skills

Preferred

• Associate’s Degree
• 3 years’ experience in claims processing and data management
• Experience in auditing and educational/training roles in coding and reimbursement

OTHER INFORMATION

This description is not exhaustive and may include additional duties. Employees must adhere to ethical standards, confidentiality, HIPAA, and company policies, including data security and privacy policies.