Professional Coding Auditor-Educator

Overview

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

• 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.

• 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.

• 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.

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

• 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.

• 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