Divisional Coding Quality Auditor & EducatorAltamonte Springs, FL

Corporate Quality Auditor (QA)/Educator

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

The role you will contribute:

The inpatient or outpatient coding team Corporate Quality Auditor (QA)/Educator is responsible for supporting the operations of the inpatient or outpatient coding teams by completing overall and account-level quality reviews of coding functions. This position assesses staff adherence to coding policies, procedures, and guidelines and regulatory guidance. This role conducts initial audits during the coder onboarding process and supports ongoing quality assurance needs for coding staff. In addition, this position reviews medical records and documentation for coding accuracy, providing feedback and additional education to correct inaccuracies. Responsible for collaborating with clinical documentation integrity specialists and revenue cycle departments when necessary to ensure documentation supports the coding of the claim. Additionally, this role equips staff with the knowledge and skills required to achieve industry best practice levels of performance.

The value you will bring to the team:

• Completes timely and accurate quality assurance audits while adhering to inpatient and/or outpatient coding policies, procedures, and established audit schedule; translates quality auditing results into practical recommendations for improvements in further standardizing audit policies and procedures actionable recommendations for improvement.
• Uses relevant references to perform audits, including but not limited to: International Classification of Diseases, Clinical Modification (ICD-10-CM and ICD-10-PCS), CPT, ICD-10-CM/PCS Coding Conventions, Official Coding Guidelines, CPT Assistant, AHA Coding Clinic, CMS guidelines, NCCI guidance, etc.
• Provides outcomes of coding quality audit reviews with leadership
• Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact
• Assists with the facilitation of scheduled external audits
• Responds to inpatient or outpatient coding questions from assigned coders/providers and provides official inpatient coding references and guidelines.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating coders, auditors, managers, and directors throughout the organization
• Will provide feedback to coding and CDI team members on escalated accounts.
• Collaborates with providers, AH Clinical, CDI, inpatient and outpatient coding staff to assist with or resolve issues relating to medical record documentation and coding.
• May participate in Iodine Retrospect inpatient reviews in partnership with CDI.
• Provides feedback on the application of coding guidelines, practices, and proper documentation techniques, and data quality improvements.
• Provides input on which quality audit and metrics will be tracked and visualized on shared dashboards to report outcomes and improve processes and workflows including programming requests, process changes, and staff accuracy and efficiencies
• Serves as point person for regional HIM/Coding teams to support quality audits and develop/ maintain reports, scorecards and dashboards that effectively tell the story of the data and highlight education opportunities in a manner that is easily understood and acted upon
• Flags data or analytics limitations, employs critical thinking and creative problem solving to address barriers, and escalates issues to leadership when appropriate
• Documents and presents findings and trends from the quality audits to the HIM/Coding leadership
• Reports any compliance and/or risk issues to the compliance department. Provides suggestions on process improvement.
• Works with the audit team and coding manager to develop meaningful education and may conduct educational huddles for inpatient coders across the organization.
• Makes recommendations to corporate coding leaders for coding policy/guideline changes, based on trending quality issues.
• Works with Epic and AIT to identify automation and system enhancements as they pertain to coding.

The expertise and experiences you'll need to succeed:

• Completion of a coding certificate program
• 5 years experience coding acute care hospital chart
• Thorough understanding of coding processes and workflows
• Expert level knowledge of disease pathophysiology and drug utilization
• Expert level knowledge of Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI), and Hierarchical Condition Categories (HCC)
• Expert level knowledge of medical terminology, coding guidelines and methodologies
• Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature (as needed to perform duties)
• Proficient in MS Office (Word, Excel, PowerPoint, Visio, Outlook, etc.) and familiarity with database programs
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient manner
• Ability to communicate professionally and effectively in English, both verbally and in written form
• Ability to follow complex instructions and procedures, with close attention to detail
• Epic experience
• Certified Coding Specialist or
• Registered Health Information Administrator or
• Registered Health Information Technician

Preferred Qualifications:

• 5 years of inpatient or outpatient coding or Coding Quality Auditor experience
• Associate in HIM field preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Health Information Management

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25038837

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.