Technical Advisor - Coding Audit & Compliance

GENERAL SUMMARY/ OVERVIEW STATEMENT:       

Under the general supervision of Manager of Audit and Compliance, the Technical Advisor supports and assists the overall Audit and Compliance Program. Assists in the development of relevant dashboards, metrics and reports regarding same. Assists in the monitoring and evaluation of third party and other outside coding audits.  Recommends and implements coder and provider education as a result of internal and external audit review. Based on coding areas(s) of focus for the Technical Advisor, works closely with entity-based CDI and quality departments in evaluating data quality and documentation improvement training needs. Interacts with site based and corporate Revenue Operations managers regarding coding specific billing, rejection and denials.

 

PRINCIPAL DUTIES AND RESPONSIBILITIES:           

Indicate key areas of responsibility, major job duties, special projects and key objectives for this position.  These items should be evaluated throughout the year and included in the written annual evaluation.

• Provides data and support to the overall coding compliance and audit program. Provides data needed to update staff, Senior Leadership and entity partners regarding audit findings and action plans as well as coding related regulatory changes and impacts.
• Assists in the development and revision of program policies and procedures and internal guidance documents.
• Recommends updates to the Coding Compliance manual.
• Works closely with coding management and Data Quality Specialists in developing criteria and evaluating the quality of coding provided by the program.
• Provides program related SME liaison as needed with entity CDI and quality teams. Serves on entity and enterprise committees as required.
• Ensures that all audit, compliance and educational activities are appropriately documented.
• Assists as SME in all aspects of internal and external coding audit activities providing root cause analysis and recommendations based on trends in findings.
• Assists with development, implementation and management of program education materials and notifications to staff.
• Recommends and/or provides coder education as required based on audit findings.
• Participates and/or facilitates staff meetings as required.
• Assists CDI teams in providing specialty-based documentation improvement education as required.
• Works closely with corporate and entity Audit and Compliance teams as required.
• Keeps abreast of all developments in the coding, audit and compliance field and continues to improve leadership and management skills through participation in professional activities, continuing education and other related activates.
• Supports Claim edits, denials and customer service inquiries as peer reviewer. 
• SME to internal departments (Vendor Management) – such as responding to vendor questions, WQ surveillance.  
• Other duties as assigned by the Coding Operations Manager or Management Team.

 

QUALIFICATIONS:       

(MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

EDUCATION:

AS/BS in Health Information Technology/Administration OR CCS with significant coding experience required. College level courses in medical terminology, biology, anatomy and physiology, basic pathology, ICD-9-CM, ICD-10-CM/PCS and CPT are required.

EXPERIENCE:

Extensive broad ranged coding experience including extensive ICD-9, ICD-10-CM/PCS and CPT-4, inpatient and outpatient coding guidelines and payor policies is required. Previous coder education experience is preferred. Strong inpatient and outpatient coding experience is required. Experience at an academic medical center is preferred; data management experience is a plus. Previous supervisory experience is a plus as well.

CERTIFICATION:

RHIA, RHIT or CCS by AHIMA or appropriate AAPC coding credentials required. Coding credential eligible may be considered with significant coding experience but coding credential would be required within 1 year of hire.

Other medical related backgrounds will be considered provided that coding related casework and experience meet requirements.

Must maintain AHIMA and/or AAPC credentialing by meeting or exceeding requirement Continuing Education Requirements and passing annual coding test required as part of credentialing maintenance.

 

SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:      

(MUST be realistic, neither overstated nor understated, and related to the essential functions of the job.)

Extensive experience with computer systems including Coding and clinical data/billing systems is required. EPIC, 3M and Nuance CDI experience is preferred.

Provides SME Coding guidance to coders, CDI nurses, clinicians and enterprise departments

Extensive Microsoft office experience, especially Word, Excel, PowerPoint and Outlook.

Excellent communication and interpersonal skills and ability to communicate effectively with all levels of the organization.

Ability to complete projects within presented timelines and deadlines.

Ability to manage multiple projects.

Strong analytical and critical thinking skills.

Ability to work independently yet remain a team player.

WORKING CONDITIONS:         

Extensive use of computer equipment and software

Frequent interaction with staff across all levels of the organization

Low physical effort

Occasional bending, stooping, kneeling, crouching and/or reaching.

Remote workers considered but may require limited travel to corporate office.