Coding Auditor - University Health Network in Knoxville, Tennessee at University Physicians' Association

University Health Network is seeking a Full-Time Coding Auditor. This role requires normal business hours Monday-Friday and is a remote position with occasional on-site meetings. Candidate must be able to maintain HIPAA privacy requirements when working from home. Candidate must be located in the Knoxville, TN region.

UHN Auditor provides superior customer experience by educating internally and externally of errors and opportunities for improvement discovered during routine auditing. This individual will work closely with management to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs. The UHN Auditor performs duties in a professional manner while exercising good judgment and ethical standards, interacts effectively and builds respectful working relationships across the organization, and demonstrates integrity by adhering to high standards of personal and professional conduct. This individual must be reliable and maintain a high level of confidentiality within all aspects of job performance.

Essential Duties and Responsibilities

• Assists Coding Manager in developing and maintaining a quality assurance program
• Performs audits and medical chart reviews contributing to the continual improvement of coding and documentation compliance performance.
• Performs routine internal audits for the UHN Coding team utilizing the UHN Audit tool to assign accuracy rates.
• Provides feedback and education to Coding Staff on accuracy scores and areas of improvement while maintaining confidentiality of individual performance.
• Works with Coding Manager on improvement plan if team member’s accuracy rate falls below industry standard and monitors if improvement plan is achieving desired outcome.
• Assists in the development of an effective training program regarding correct coding techniques.
• Performs external coding audits for providers and creates audit summary reports with education topics.
• Delivers Audit results and educational opportunities to providers
• Assists in development of educational materials regarding compliant coding practices
• Acts as a Subject Matter Expert in coding and documentation compliance
• Conducts special studies/projects as requested to identify opportunities for operational improvements
• Assists in the maintenance and creation of departmental policies and procedures to ensure compliance with established State and Federal regulations.
• Monitor database entries to ensure data is complete, accurate, and thorough
• Remains current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and CMS Risk Adjustment guidance.
• Performs ambulatory and inpatient coding assignments as needed to meet department deadlines.

Maintains HIPPA Guidelines for privacy

• Respects the privacy of all patients 100% of the time
• Obtains consent to release protected health information
• Understands and abides by the HIPAA policy set forth by UHN
• Reports all HIPAA issues to the Office Supervisor

Remains current on coding rules and guidelines

• Remains up to date with official AMA ICD-10 coding guidelines and regulations, Medicare, other MA and commercial plans, and internal guidelines
• Remains up to date with CMS and HHS HCC risk adjustment models
• Ensures coding staff is current on coding rules and guidelines
• Meets CEU requirements and remains in good standing with AAPC/AHIMA certifications

• 3+ years of ICD-10, CPT, and HCPCS coding experience required.
• Experience and knowledge of Risk Adjustment Coding.
• Current certifications required: CPC (RHIT also accepted) and CPMA.
• Certified Risk Adjustment Coder (CRC) required within 6 months of hire.
• Thorough understanding of healthcare compliance with experience in auditing E/M services and providing professional constructive feedback regarding billing and documentation practices.
• Thorough understanding of Medicare/Medicaid billing regulations and documentation guidelines.
• Strong knowledge of chart auditing/abstracting process.
• Effective communication, relationship-building and interpersonal skills.
• Exceptional attention to detail and proficiency in Microsoft Word and Excel.
• Strong organizational and time management skills.
• Ability to work independently and meet quality of work and workload expectations.
• Strong analytical and problem-solving skills.