Coding Data Quality Auditor / Educator Specialist

WELLBE INTRODUCTION

The WellBe care model is a Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients.  This population is typically underserved and very challenged with access to care.   To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care.  WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

GENERAL SUMMARY

Performs functions as both coding data quality auditor/educator and is responsible for providing oversight on education and audits of medical records in compliance with federal coding regulation and guidelines. As the coding data quality auditor, you are responsible for the coordination of auditing and education in support of achieving organizational strategic initiatives. You will use results to generate topics for education, training, process changes, risk reduction and VBC coding optimization in accordance with coding principles and guidelines. 

The Coding Data Quality Auditor will be responsible to assist in achieving teams’ goals. Uses knowledge of WellBe policies and procedures to provide a second level review of all codes (CPT, HEDIS, EM, ICD-10 etc.) for compliance with educational objectives in strict adherence to Official ICD‐10‐CM Guidelines for Coding and Reporting, AHA Coding Clinic and CMS. When needed this role will assists with coding production as needed; reviews and resolves coding issues related to billing, research complex coding issues and will be an active participant in process improvement and problem resolution.

SKILLS & COMPETENCIES

• Practices the WellBe mission: To help our patients lead healthier, meaningful lives by delivering the most Complete Care.
• In-depth knowledge of CPT, ICD-10-CM and CMS HCC coding systems 
• Knowledge of CPT II and awareness of HEDIS Measures 
• Conducts audits and reviews of medical record documentation and coding by market
• Ability to mentor, educate and train others on coding systems, documentation and compliance matters
• Ensures external and internal audit recommendations are completed timely (i.e. coding education, coding changes, rebills, etc.).
• Organizes, facilitates, performs, tracks, trends, and reports on internal reviews to stakeholders
• Understanding of local and federal regulatory agency guidelines regarding coding, documentation and submission as well as areas of scrutiny for potential areas of risk for fraud and abuse regarding coding and documentation
• Utilize analytics to identify opportunities of improvement and education
• Develops and maintains coding related policies, procedures, query development, work queues and training materials in conjunction with coding and clinical operations leadership.
• Be able to handle high stress and critical situations in a calm and professional manner
• Be able to concentrate and maintain quality and accuracy during interruptions
• Independent decision-making ability, organizational and time management skills
• Ability to prioritize job duties and adapt to changes in the workplace and work assignments
• Participates in regularly scheduled team meetings
• Other tasks needed to accomplish team’s objectives/goals

Educational/Experience Requirements:

• 5+ years’ progressive outpatient coding experience that includes but not limited to assignment of E&M levels, CPT II and CMS HCC Coding. 
• Associate’s degree in Health Information Technology or related field, or Equivalent experience, education and/or training may be substituted for the degree requirements.
• Bachelor’s degree in Health Information Management or related field-preferred
• CRC Certification required as well as one of the following certifications: RHIT, CCS-P, CCS or CPC 
• RHIA certification-preferred
• CPMA, CDEO and/or CDIP certification-preferred 

Required Skills and Abilities:

• Auditing experience and/or strong education and training background in coding and reimbursement.
• Strong interpersonal skills, good verbal and written communication skills and comprehensive knowledge of outpatient coding, CMS HCC, billing, VBC and regulatory requirements. 
• Proficiency in office software programs, including medical record systems
• Demonstrates professionalism, tact, and diplomacy when working with the clinical staff, outside organizations and other internal departments. 
• Experience abiding by the Standards of Ethical Coding as set forth by AHIMA and AAPC

Supervisory Responsibility: No supervisory responsibilities.

Travel requirements: Travel may be required up to 25% locally or nationally

Work Conditions: Ability to lift up to 20lbs.  Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. 

• Ability to stand for extended periods
• Ability to drive to patient locations (ie. home, hospital, SNF, etc)
• Fine motor skills
• Visual acuity.

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification.  Management reserves the right to add, modify, change or rescind the work assignments of this position.  Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.