Job Category:

Revenue Cycle

Work Shift/Schedule:

Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Coding Education & Quality Auditors (CEQA) conduct coding/billing/documentation audits of all NGPG/NGHS Providers to determine organizational integrity of coding/billing for professional services, including detection and correction of documentation, coding and billing errors. Audits consist of evaluation of the adequacy and accuracy of documentation to support services billed including ICD-9/ICD10/CPT/HCSPCS and other third-party payer codes. CEQAs ensure the medical necessity of services, compliance with other documentation, coding and billing standards. CEQAs apply standardized audit scoring methodology to evaluate consistency of documentation and coding, and standardized audit findings methodology to report audit results. CEQAs communicate audit results to physicians, physician leadership, senior management, Compliance department and staff. CEQAs are required to provide physician and coder education, and make recommendations to management for corrective action.  CEQAs serve as an institutional subject matters expert and resource on interpretation and application of documentation and coding rules and regulations. CEQAs assure the quality of the coding documentation fits service and codes, and any missing labels on documentation are corrected. 
 

Minimum Job Qualifications

• Licensure or other certifications: CPC and/or CCS-P Coding Certification. CPMA, CEMC or other Nationally recognized healthcare auditing certification required at hire, or required to obtain within 6 months of hire.

• Educational Requirements: High School Diploma or GED.

• Minimum Experience: Minimum three (3) years experience coding and/or auditing Multi-Specialty records required; Medical Terminology or Anatomy course required. Demonstrated experience in conducting education to providers and large audiences required.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Detailed knowledge of ICD-9, ICD-10, CPT and HCPCS coding principles and medical terminology

• In-depth knowledge of best practice coding policy and procedures 

• Highly skilled proficiency with Microsoft Office products, advanced proficiency in Excel and Powerpoint

• Ability to communicate (both verbally and written) technical coding information to both technical and non-technical audiences

• Ability to organize data and provide detailed reporting

• Ability to prepare presentations and present to large or small audiences

• Must be highly motivated, organized, and a detail oriented individual

• Excellent communication (written, verbal and presentation) and people-facing skills

• Strong analytical and interpersonal skills

• Ability to be a self starter/work independently and as a team player

• Ability to travel to NGHS/NGPG sites on a regular bases

• Understanding of current regulatory and third party requirements 

• Accuracy and attention to detail required

• Establishes and maintains positive peer, leadership and customer relationships, interacting positively and productively with teams across organizational lines.

• Positive work ethic with proactive and team oriented style

• Must posses a confident, friendly demeanor
   

Essential Tasks and Responsibilities

• Coordinates, schedules, performs the professional services documentation and coding audits of outpatient records for NGPG/NGHS.

• Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported.

• Audits codes and professional fee services performed by providers from medical records according to ICD-10, CPT, HCPCS, and CMS guidelines.

• Audits every charge for new providers, PRN providers, locum providers, and any under compliance audit daily, till said provider passed an audit. 

• Meets with the providers to review the audit findings and to recommend ways to improve when indicated.

• Orients and trains new provider