Professional Coding Auditor-Educator

WVU Medicine; Madison (WI); On-site; USD 70,000 - 90,000; Full time

Job summary

A healthcare organization is seeking a Professional Coding Auditor-Educator to train coding staff, perform quality audits, and develop coding policies. Candidates should have a valid medical coding certification and extensive coding experience in relevant systems. This role is crucial for maintaining compliance and improving coding accuracy within the organization.

Qualifications

• Minimum education: HIT graduate or equivalent, or medical coding certification with five years of coding experience.
• Certification in RHIT, RHIA, COC, CCS, or CPC required.
• Extensive coding experience with knowledge of governmental regulations.

Responsibilities

• Educate and train coding staff.
• Perform coding quality audits and feedback.
• Develop and maintain coding-related policies and training materials.

Skills

Excellent written and verbal communication

Knowledge of healthcare compliance

Ability to analyze complex data

Proficiency in office software

Education

Graduate of Health Information Technology (HIT) or equivalent program

Medical Coding Certification Program

Bachelor’s degree in Health Information Management

Tools

ICD-10-CM

ICD-10-PCS

CPT

medical record and billing systems

Job description

Overview

Professional Coding Auditor-Educator role at WVU Medicine. To apply, click the Apply button and complete the application in full.

Responsibilities

• Educate and train WVU Healthcare Coding Staff as directed by Coding Managers.
• Oversee or perform the overall auditing and education plans for the Coding staff.
• Perform coding quality audits, provide ongoing feedback and education.
• Utilize ICD-10-CM, ICD-10-PCS, CPT, and other references and software to ensure accurate coding and MS-DRG, HCC and APR-DRG assignment.
• Develop and maintain coding-related policies, procedures, query development, work queues and training materials in conjunction with management.
• Communicate with Coding Staff, Medical Staff, Physician Advisor, Department Chairman, and Department Administrators.
• Organize, facilitate, perform, track, trend, and report on internal quality reviews.
• Design and use audit tools to monitor coding accuracy and documentation gaps; coordinate external audits and related reporting.
• Coordinate denials reviews and facilitate appeal letter formation; handle RAC and third-party payor denials.
• Ensure audit recommendations are implemented (e.g., coding education, changes, rebills) and monitor action plans.
• Assist with onboarding of new Coding Specialists and keep staff updated on compliance and regulatory changes.
• Stay current with coding changes, state and federal regulations, and coding resources.
• Develop curriculum for WVU Healthcare Coding Certificate Program as needed and participate in related system upgrades and testing.

Qualifications

• Minimum qualifications:
  • Education: Graduate of Health Information Technology (HIT) or equivalent program AND five (5) years of coding experience; OR
  • Medical Coding Certification Program AND five (5) years of coding experience; OR
  • High School Diploma or Equivalent AND eight (8) years of coding experience.
• Certification in one of the following: RHIT, RHIA, COC, CCS, or CPC.
• Preferred qualifications: Bachelor’s degree in Health Information Management or related field.
• Experience: Extensive experience in ICD-10-CM, ICD-10-PCS, CPT, MS-DRG, HCC and APR-DRG assignment; knowledge of governmental billing and coding regulations including Teaching Physician Guidelines; supervisory or project management experience.

Physical Requirements

• Sit for long periods; visual and hearing acuity within normal range; manual dexterity to operate computer and office equipment.
• Ability to lift, push or pull 10-20 pounds.

Working Environment

• Standard office environment; potential visual strain from screens; may require travel.

Skills and Abilities

• Excellent written and verbal communication; ability to mentor, educate and train others.
• Knowledge of provider healthcare compliance, revenue cycle operations, and auditing techniques.
• Ability to analyze complex data, manage priorities, and adapt to changes; strong organizational and time management skills.
• Proficiency in office software and medical record and billing systems.

Job Details

• Scheduled Weekly Hours: 40
• Exempt/Non-Exempt: Exempt
• Shift: United States of America (Exempt)
• Company: SYSTEM West Virginia University Health System
• Cost Center: 539 SYSTEM HIM Provider Based Coding Analysis