Coding and Revenue Auditor (Remote, WA residents only)

* VALLEY MEDICAL CENTER • Job Description • Patient Financial Services • * The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization. • TITLE: Coding and Revenue Auditor JOB OVERVIEW: The Professional Services Coding and Revenue Auditor is responsible for taking an instrumental role in auditing of all healthcare professionals involved in professional fee coding and documentation at UW/Valley Medical Center. In cooperation with the Manager, Revenue Charge Capture, Coding Management and Corporate Compliance, this position is responsible for performing new physician and annual physician coding and documentation audits. This role will collaborate with the Manager, Revenue Charge Capture on recommended education opportunities for VMC billing providers and assist with research on complex coding and billing subject matters. DEPARTMENT: Patient Financial Services WORK HOURS: Typically, Monday - Friday 8:00 am - 4:30 pm. Hours may vary as required. REPORTS TO: Manager, Revenue Charge Capture PREREQUISITES • Minimum three (3) years' experience in medical record documentation review, diagnosis, and procedure coding, and/or auditing required. • Two (2) or more years' experience in professional fee documentation and coding auditing preferred. • Two (2) years' experience performing, analyzing, and providing feedback on physician documentation and coding audits required. • Excellent Oral and Written Communication. Demonstrates articulate and concise oral communication; as well as ability to write clearly and concisely. • Advanced knowledge of ICD-10 CM/PCS • Risk Adjustment Reporting (HCC) experience preferred. • Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required. • Certified Evaluation and Management Coder (CEMC) preferred. • Certified Professional Medical Auditor (CPMA) strongly preferred. QUALIFICATIONS: • Demonstrates a working knowledge of Risk Adjustment Reporting based on HCC documentation. • Capable of working both in a team and individual environment and is confident working with a variety of healthcare professionals to ensure ongoing coding compliance. • Heightened understanding of ICD-10-CM. • Capable of coding across several specialties and varying degrees of complexity in CPT-4, HCPCs, and ICD-10-CM systems consistent with UW/Valley Medical Center expectations of accuracy. • Expert in Medicare/Medicaid and all coding-related CMS guidelines, as well as comprehensive understanding of HCC's and Risk Adjustment reporting, and reimbursement systems. • Practical knowledge and understanding of official Evaluation and Management (E & M) guidelines and documentation requirements across a wide range of specialties, in support of proper E & M code assignment and establishment of medical necessity. • Commitment to continuously increasing knowledge of, and familiarity with constantly changing updates in the business practices of medicine directly impacting provider coding, billing, and reimbursement. • High-level thinker with the ability to analyze complicated materials, such as coding and documentation audits, and place in a format all knowledge levels can easily understand. • Highly organized, works well independently. • Strong communicator, both written and verbal. • Demonstrated ability to meet strict deadlines, with good time management and prioritization skills. • Proficient in anatomy, disease and diagnosis, pharmacology, and medical terminologies. • Demonstrated ability to use various computer applications, including Microsoft Office; EXCEL, WORD and PowerPoint, as well as familiarity with Epic system preferred. • Familiarity with personal computers, spreadsheets, and Epic system software preferred. UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS: Requires legible handwriting and computer/keyboarding skills. Excellent telephone etiquette/skills are essential. Regular and punctual attendance is a condition of employment. Requires the ability to maintain self-composure and a positive attitude under stress. Requires flexible scheduling and extended hours as needed. Requires problem solving and coaching ability and effective conflict resolution. PERFORMANCE RESPONSIBILITIES: • Generic Job Functions: See Generic Job Description for Administrative Partner. • Essential Responsibilities and Competencies: • Collaborates with the Manager, Revenue Charge Capture on educational programming for coding staff, and providers of all levels as they relate to coding and, clinical documentation. • Collaborates with the Manager, Revenue Charge Capture in the creation of documentation and coding job aids and best practice tools related to E&M, procedure and diagnosis coding for providers. • Performs medical chart reviews to ensure all diagnosis and procedure codes that are submitted are appropriate, accurate and sufficiently supported by written clinical documentation including co-morbidities. • Conducts and provides feedback through coding and documentation audits for accuracy and compliance. Utilizes these results to identify trends or variances in coding that require additional education for performance improvement. • Identifies coding education opportunities for PB coding staff and effectively communicates documentation review findings to the PB coding team leadership. • Ensures compliance through demonstrated knowledge of Federal regulatory and Commercial payer guidelines for documentation, coding and billing. • Assists in the creation of departmental policies and updates forms and manuals to remain current and effective. • Maintains current on any regulation, best practices, or processes related to the implementation of ICD-10-CM and provides education and knowledge to all affected providers and staff members. • Performs new provider audits per departmental policy analyzing trends for educational opportunities. • Performs annual provider audits in accordance with the UW Compliance Office's established schedule. • Evaluates policies and procedures to improve the quality and outcomes of coding and revenue cycle performance. • Monitors user performance in conjunction with appropriate management team. • Develops and maintains quality controls through auditing outpatient practices for coding compliance and effectively communicates identified errors to appropriate management team. • Performs QA on hospital outpatient and professional services, to include outpatient surgeries, E/M services, procedures and diagnoses) as needed. • Communicate QA performance results to individual staff members • Retains a professional appearance while personifying UW/Valley Medical Center's mission with interactions with colleagues, staff, physicians, patients, and/or any other individual while on facility grounds. • Maintains confidentiality of information pertaining to department personnel records and other protected health information. • Performs all job functions and any others required, in a manner consistent with Valley's cultural expectations defined as Valley Values. These characteristics include quality performance, demonstrating compassion, respect, teamwork, community-centered awareness and innovation. • Performs other related job duties as required. Revised: 12/24 Grade: NC06 FLSA: NE CC: 8531 Job Qualifications: PREREQUISITES • Minimum three (3) years' experience in medical record documentation review, diagnosis, and procedure coding, and/or auditing required. • Two (2) or more years' experience in professional fee documentation and coding auditing preferred. • Two (2) years' experience performing, analyzing, and providing feedback on physician documentation and coding audits required. • Excellent Oral and Written Communication. Demonstrates articulate and concise oral communication; as well as ability to write clearly and concisely. • Advanced knowledge of ICD-10 CM/PCS • Risk Adjustment Reporting (HCC) experience preferred. • Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required. • Certified Evaluation and Management Coder (CEMC) preferred. • Certified Professional Medical Auditor (CPMA) strongly preferred. QUALIFICATIONS: • Demonstrates a working knowledge of Risk Adjustment Reporting based on HCC documentation. • Capable of working both in a team and individual environment and is confident working with a variety of healthcare professionals to ensure ongoing coding compliance. • Heightened understanding of ICD-10-CM. • Capable of coding across several specialties and varying degrees of complexity in CPT-4, HCPCs, and ICD-10-CM systems consistent with UW/Valley Medical Center expectations of accuracy. • Expert in Medicare/Medicaid and all coding-related CMS guidelines, as well as comprehensive understanding of HCC's and Risk Adjustment reporting, and reimbursement systems. • Practical knowledge and understanding of official Evaluation and Management (E & M) guidelines and documentation requirements across a wide range of specialties, in support of proper E & M code assignment and establishment of medical necessity. • Commitment to continuously increasing knowledge of, and familiarity with constantly changing updates in the business practices of medicine directly impacting provider coding, billing, and reimbursement. • High-level thinker with the ability to analyze complicated materials, such as coding and documentation audits, and place in a format all knowledge levels can easily understand. • Highly organized, works well independently. • Strong communicator, both written and verbal. • Demonstrated ability to meet strict deadlines, with good time management and prioritization skills. • Proficient in anatomy, disease and diagnosis, pharmacology, and medical terminologies. • Demonstrated ability to use various computer applications, including Microsoft Office; EXCEL, WORD and PowerPoint, as well as familiarity with Epic system preferred. • Familiarity with personal computers, spreadsheets, and Epic system software preferred. 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