PPG Auditor/Educator

Phoebe Putney Health System; Albany, Northern (GA, KY); Hybrid; USD 65,000 - 85,000; Full time

Job summary

Phoebe Putney Health System is seeking a Coding Auditor/Educator to audit medical record documentation and coding for accurate ICD-10-CM/PCS and HCPCS coding used in billing, reporting, and compliance. The role educates physicians and clinical staff to ensure complete documentation and resolves discrepancies to support compliant coding practices.

The role also trains coders on reimbursement guidelines and develops training materials, serving as an advisory resource to the coding staff, clinical

Qualifications

• 2 year / Associate's Degree in related field; In leu of Associates Degree, eight (8) years directly related experience (Required)
• Experience with ICD-10, CPT, and HCPCS coding is required.
• Knowledge of healthcare revenue cycle and coding management in a physician practice/clinic setting preferred.

Responsibilities

• Audit medical record documentation and coding for billing and reporting.
• Educate physicians and clinical personnel to ensure complete documentation and resolve incomplete information.
• Query physicians to resolve discrepancies for compliant coding and billing.
• Educate and train coders on coding and reimbursement guidelines and career ladder development.
• Research audit results and denials to support appeals and staff education.
• Serve as advisor to coding staff, clinical staff, and physicians on documentation and regulatory compliance.

Skills

ICD-10-CM/PCS coding

CPT coding

HCPCS coding

Medical terminology

Revenue Cycle experience

Education

Associate's Degree in related field

Eight years related experience in lieu of degree

Tools

Athena

Meditech

Job description

Job Summary

Audits medical record documentation and coding to extract data and determine appropriate ICD-10-CM/PCS and HCPCS codes for billing, internal and external reporting, and compliance with the Official Coding Guidelines for Coding and Reporting, payer regulations, and Clinic/hospital policy. Educates physicians and clinical personnel to ensure complete documentation in the medical record and queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices. Educates and trains coders to ensure both a working knowledge of coding and reimbursement guidelines and successful career ladder completion, including the development of training materials and reference documents. Researches audit results, error reports, and denials and resolves by successful appeal, staff education, and correction of discrepancies. Serves in an educational and advisory capacity to the coding staff, clinical staff, and physicians as it relates to documentation, coding, and regulatory compliance. The CBO coding Auditor/Educator reports to the CBO Coding Manager.

Qualifications

2 year / Associate's Degree in related field; In leu of Associates Degree, eight (8) years directly related experience (Required)

Work Experience

• 4 years Experience with ICD-10, CPT, and HCPCS coding (Required)
• 4 years Extensive knowledge of medical terminology (Required)
• 4 years of related Revenue Cycle healthcare experience, preferably within coding and billing (Preferred)
• 3 years of experience in health information management or coding management in a physician practice/clinic setting (Preferred)
• Prior Athena or Meditech experience. (Preferred)
• Experience with any of Phoebe Provider Group’s legacy financial systems (Preferred)

Licenses and Certifications

Required Certifications/Licensures:
CPMA, Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), or Certified Professional Coder (CPC)

Additional Duties

• Adheres to the hospital and departmental attendance and punctuality guidelines.
• Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current Knowledge in present areas of responsibility to include any specialty certification requirements (i.e., self-education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs. For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
• Wears protective clothing and equipment as appropriate.