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Yale New Haven Health · 1 day ago

ED Outpatient Auditor/Educator (Remote)

United States

Full-time

Remote

Senior Level

5+ years exp

Yale New Haven Health is seeking an ED Outpatient Auditor/Educator to develop an educational pathway for outpatient coders. This role involves coordinating quality assurance reviews, conducting audits, and providing training to ensure high coding quality and compliance within the department.

Health Care

Responsibilities

Coordinates activities with internal and external educational partners (Inpatient Coding Educator/Auditor, American Coding School, AHIMA Foundation Apprentice Program, Nosology, etc.) to: identify cases for internal audits, American Coding School and for apprentice staff on an ongoing basis; and meet with staff to assess their knowledge of specific coding topics and identifies those case types for review

Conducts and coordinates Quality Assurance reviews and other compliance audits, including rebuttal process and one-to-one discussions with coders, providing educational resources where necessary. Develops and provides individualized training based on audit findings for coders with suboptimal quality scores. Performs ongoing audits of coders with less than optimal coding quality and provide ongoing feedback until greater than 95% accuracy is attained. Conducts ad hoc audits on an ongoing basis. Provides coding audit outcomes to Coding management teams and develops a remediation plan.2. a. Tracks the audits and education on an ongoing basis

Develops coding procedures and `how to' and "tips and tricks" guides for coders, and updates workflow procedures as needed

Surveys staff to determine areas where further instruction would be useful (i.e. spinal fusions, hysterectomies, etc.) and coordinates educational sessions to address these areas

Coordinates review and education of annual/regular ICD-10-CM and PCS/CPT code updates, deletions, additions as well as APC changes and any reimbursement/regulatory changes

Tracks all educational presentations developed internally as well as education log for staff and current proof of staff certifications. Communicates to coding leadership when certification, education and competency requirements are not being met by Coding staff

Coordinates on-boarding of new coders - tracking progress, identifying opportunities/resources to enhance staff's skill set, knowledge base, etc

Identifies inconsistencies, which may indicate potential problems, which could impact on department efficiency. Makes recommendations to streamline activities and procedures to support the coding unit

Responds to inquiries from other departments regarding coding; acts as a liaison to the billing office as a coding content expert

Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with management

Leads training sessions and presents high-level education on coding guidelines/information to coders, which includes presenting PowerPoint presentations and webinar-type meetings. Coordinates training and orientation of new staff, as well as existing staff wishing to pursue promotion

Assesses coders' comprehension of training, and tracks and reports coding education results to coding leadership. Identifies need for one-on-one coding sessions and develops follow-up educational plans as needed. Collaborates with coding leadership to ensure coders receive sufficient and focused education

Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a preceptor, mentor and resource to less experienced staff

Develops and performs audits to help determine and validate documentation and coding issues and gaps; analyzes audit results and identifies patterns, trends and variations in coding and documentation practices; and makes recommendations for improvement. Develops and implements training when educational needs have been identified

Maintains current knowledge of coding, federal and local regulations. Performs other duties as assigned

Performs coding functions as needed to maintain coding skills and maintain a comprehensive understanding of the coding workflows

Qualification

Outpatient coding expertiseAAPC certificationICD-10 knowledgeEHR experienceEpic experienceTrainingEducationAnalytical skillsMicrosoft Office proficiencyMedical terminology knowledgeCritical thinkingCommunication skillsPresentation skillsMentoring skills

Required

Bachelor's degree in HIM or related field or equivalent preferred

Five (5)+ years progressively complex coding and/or auditing work experience required

Expert coding knowledge, including in-depth understanding of coding guidelines, conventions, CPT, and Evaluation & Management classification systems and knowing how to utilize resources available to answer questions

Experience with the electronic health record (EHR) and health care applications required

Must have past experience with training and education in large and small groups

Must be a certified coder through AAPC with a COC (certified outpatient coder) and either has or will have an instructor designation through the AAPC within six months

Must have or will have their CCC and CIRCC credential within first year

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision

Must possess well developed communication (written and verbal), analytical, and presentation skills

High level of competency with Microsoft Office tools

Advanced knowledge of disease processes, ICD-10, CPT and HCPCS coding applications, clinician documentation, and HIM department responsibilities of government regulations and areas of scrutiny for potential fraud and abuse

Ability to review analyze and interpret billing guidelines and state and federal regulations

Ability to create training material and presentations

Demonstrated ability to mentor, educate and train others

Possesses the ability to work with individual's at all organizational levels, particularly peers, team members and other departments

Advanced knowledge and understanding of anatomy, physiology, and medical terminology

Preferred

Epic experience preferred

Additional coding certifications in the field highly desired

Company

Yale New Haven Health

Glassdoor3.7

Yale New Haven Health is making it easier for people to access the latest medical treatments, advanced research and innovations through our five outstanding hospitals – Yale New Haven, Bridgeport, Greenwich, Lawrence + Memorial and Westerly – and our affiliation with the prestigious Yale University and its highly-ranked Yale School of Medicine.

Founded in 1996

New Haven, Connecticut, USA

10001+ employees