Coding Auditor / Educator

Description

Tennessee Orthopaedic Alliance is the largest orthopedic surgery group in Tennessee. TOA concentrates on the diagnosis and treatment of disorders and injuries of the musculoskeletal system which allow our patients to live their best life. Ninety plus years later we are advancing the practice of orthopedic surgery throughout the state.

There are several reasons why TOA is an employer of choice; here are a few of them:

• Stability - TOA has been in Middle Tennessee since 1926 and has expanded to over 20 locations statewide!
• Impact - TOA's team members use our careers — whether in our clinics or our business office — to make a positive difference in the community by building relationships and helping patients live their best life.
• Work Environment - The TOA team focuses on fostering an excellent working environment; one of positivity, collaboration, job satisfaction, and engagement.
• Total Rewards - TOA offers competitive salaries based on the current Tennessee wage market, plus a comprehensive suite of benefits, including Medical, Dental, Paid Time Off, and more. Our 401(k) plan provides a company match, safe harbor match and profit-sharing match to go along with your contributions.

The position provides auditing services to ensure accurate and ethical coding of documentation and claims generation. The auditor/educator assists in providing educational training and understanding to physicians, mid-levels, clinical personnel, and revenue cycle teams. The auditor/educator will have effective communication skills via verbal and written and will be able to speak with providers and clinical team members confidently.

Responsibilities

• Follows the direction of the Revenue Cycle Director regarding all assigned coding duties.
• Perform physician documentation audits including reviews of medical records and charges to ensure compliance with coding standards.
• Perform mid-level documentation audits including reviews of medical records and charges to ensure compliance with coding standards.
• Perform evaluation and management, surgical, and ancillary service audits including reviews of medical records and charges to ensure compliance with coding standards.
• Provide education/training to providers, clinical team members, coding team members and other individuals on the revenue cycle team.
• Assist in the development, documentation, and maintenance of an effective auditing program.
• Assist in the development, documentation, and maintenance of an effective coding educational program.
• Conduct meetings with physicians and mid-level providers to include chart reviews, coding reviews for over/under coding patterns, coding patterns in general, and code specific revenue enhancement opportunities.
• Perform pre-bill & post bill audits of new physicians and mid-levels as they join Tennessee Orthopedics Alliance.
• May assist in payer audits and retrospective audits requiring pay backs to either commercial or governmental payers.
• May assist with new on-boarding of providers on new physician audits, documentation review, spot auditing and coding accuracy.
• Provide coding education regarding orthopedic ancillary services, modifiers, and bundling of services.
• Must know and understand CRT and RAC processes.
• May assist in or conduct special audit as requested by leadership.
• Travel within middle TN is required to complete provider feedback meetings and new provider training.
• Conduct chart audits, report outcomes to compliance team & provide on-going education to providers on ICD-10, CPT & HCPCS coding systems.
• Develop standards and guidelines for medical record documentation including reporting on deficiencies and training to remediate.
• Coordinate with Compliance Manager on coding documentation issues as needed.

Requirements

Among the qualifications for our Coding Auditor / Educator:

• 5 years of coding experience with extensive knowledge of ICD-10, CPT-4, and HCPCS II coding systems.
• Certification/Licensure: CPC or CCS-P certification or equivalent along with maintenance of continuing education requirements.
• CPMA auditing certification or equivalent required upon employment or within first full year of employment. TOA will cover the cost of the AAPC exam prep training course not to exceed $1,500 and AAPC exam session not to exceed $500.
• Experience conducting coding education to coding staff, physicians, and mid-level providers.
• Team-oriented and adaptable
• Problem-solving skills

TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers.