Coding Auditor Educator (4841)

at SIU Medicine in Springfield, Illinois, United States

Job Description

Description
The primary purpose of this position is to assist with training and teaching continuous education to coding staff, clinical staff and providers. This incumbent will perform audits and monitor all coding activities for the clinical departments of Southern Illinois University Medicine (SIU Medicine) including but not limited to: training of coding staff, audit of clinical documentation in comparison to CPT code selection, analysis of coding denials to utilize in an audit capacity assisting in the education of coding staff, and provide support, input and applicable training for existing and new systems implementations as well as federal/state mandates. This position will serve as a primary administrative figure for the SIU Medicine coding staff that provides coding support for SIU Medicine providers.

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 Examples of Duties
60% Administrative
1) Conduct training of new and current staff in the coding unit and clinical departments.
2) Develop and implement necessary policies and procedures for the coding unit.
3) Design, update, and print charge tickets as necessary to maintain compliance with
coding guidelines and updates. Work with clinical department staff for input and
approval.
4) Attend faculty/divisional meetings to inform faculty and staff of new coding issues
specific to their division and also of recurring problems with functions such as
completion of charge ticket, etc.
5) Identify potential compliance issues and report to supervisor and/or Office of
Compliance.

35% Coding and Reimbursement
1) Provide expert advice and guidance to administrators, faculty, staff and other SIU
departments regarding coding, documentation, and other third party payer
guidelines.
2) Research and advise faculty of new CPT and ICD10 codes for proper use and billing
requirements, including researching reimbursement rates and documentation
requirements.
3) Assist in resolving complex account problems, specific to coding related
issues/denials, and approve account maintenance adjustments in compliance with
Department, University, and third party payer guidelines.
4) Review coding and reimbursement rules and using appropriate resources to keep
updated on policy changes. Communicate changes to faculty and staff.
5) Review documentation, including clinic notes and consultative and operative reports,
to determine the appropriate level of evaluation and management services was
provided as well insuring all procedures and modifiers are captured and submitted
for billing.
6) Conduct training sessions for faculty, residents, administrators and staff on CPT and
ICD10 coding and third party payer submission and billing guidelines based on
outcomes of coding audits and denial analysis.
7) Assist with maintaining the Experian claim scrubber edit system which includes
support to peers regarding questions related to edits, rules, workflows, etc. Create
and modify edits as requested to address issues identified via audits, coding denials
or result of new federal/state mandates.

5% Miscellaneous
1) Attend seminars and/or read publications to increase knowledge and understanding
of CPT and ICD10 coding and billing processes as well as to remain up to date
regarding reimbursement policies of payers such as Medicare, Medicaid and
managed care payers.
2) Other duties as assigned.
 Qualifications

High school graduation or equivalent.
Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification).
Three (3) years (36 months) of total work experience, two (2) years (24 months) of which are comparable to that performed at the Reimbursement Coding Specialist level of this series or in other positions of comparable responsibility.
Supplemental Information

If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.
The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

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Southern Illinois University School of Medicine is an Equal Opportunity Employer.