Job Code/Title: H0042/ Medical Coding Analyst Auditor/ Educator
FLSA: Non- Exempt
OPEN UNTIL FILLED
UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNM Medical Group, Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.
Assists Medical Coding Management in organizing, managing, performing, and reporting of UNMMG Medical Coding Analysts (MCAs) audits for professional fee billing. Assists Medical Coding Manager and Director in providing guidance and leadership to MCAs to ensure compliant coding based on audit findings and Provider Medical Record Documentation. Works with Medical Coding Management to develop and implement standard operating auditing procedures and educational training plans for the Medical Coding Department; coordinates and evaluates curriculum development. Conducts the preparation and delivery of medical coding education to improve coding accuracy and production. Works with Medical Coding Manager in providing “Onboarding” education and training of newly hired Medical Coding Analysts.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Reporting to Manager, Medical Coding, responsible for the quarterly medical coding audits and monthly educational sessions for the UNM Medical Group, Inc., Medical Coding Analysts. Works closely with the Coding Supervisors, Manager and Director to identify areas and make recommendations for educational improvement for both coding staff and medical providers as needed.
Duties and Responsibilities
- Assesses the auditing and medical coding educational needs of professional fee Medical Coding Analysts and develops programs and researches educational resources to meet those needs.
- Develops training materials and medical coding aids for use by MCAs in daily work.
- Responsible for performing medical coding audits for all UNMMG professional fee coding staff to assure coding accuracy and prepares reports and observations.
- Responsible for follow-up feedback and working in conjunction with Medical Coding Leadership to improve coder accuracy when inappropriate coding patterns are identified and accuracy goal is not met.
- Responsible for working in conjunction with Medical Coding Leadership in providing 1:1 and/or group educational coding sessions for MCA and UNMMG medical providers.
- Serves as a TES/Claims Manager edit resource to ensure medical coding edits are as current as possible and meet professional documentation and medical coding standards; reports and revises TES Edit information when inaccurate.
- Reviews and analyzes CMS, Federal, State, and other billing guidance agencies to ensure Medical Coding Department guidelines are accurate and kept up-to-date to reflect any changes or updates that are utilized by medical coding staff.
- Assists Medical Coding Management in the formulation of the annual work plan to capture risks in audit plan.
- Provides “On Boarding” education and training of all newly hired Medical Coding Analysts.
- Ensures strict confidentiality of medical and financial records.
- Attends medical coding conferences, workshops and in-house sessions to receive updated coding and auditing information and changes to regulations.
- Performs miscellaneous job related duties as assigned.
Minimum Job Requirements
High school diploma or GED with 2 years directly related experience. Must be a CPC (Certified Professional Coder) and CPMA (Certified Professional Medical Auditor) or certificate eligible to pass CPMA within 6 months of employment. Verification of education and licensure (if applicable) will be required if selected for hire.
Knowledge, Skills and Abilities Required
- Advanced comprehensive knowledge of medical anatomy, terminology, ICD-10 and CPT/HCPCS medical coding.
- Advanced knowledge of medical record auditing concepts and principles, as well as medical record auditing skills and abstraction.
- Advanced knowledge and increased awareness of legal, regulatory, and compliance issues related to medical coding and billing procedures as well as documentation requirements (i.e., Federal, State, and third party payer regulations).
- Advanced knowledge of fraud, waste and abuse penalties for medical documentation violations based on governmental guidelines, medical coding concepts, scope and statistical sampling methodologies.
- Ability to analyze Federal, State, and other medical coding and billing rules and regulations and to develop guidelines to assist MCAs in medical coding/billing based on proper medical record documentation requirements.
- Ability to perform quality assurance, medical coding risks analyses and communicates results and observations.
- Ability to identify and interpret documentation and medical coding training needs.
- Ability to design, develop, implement and evaluate training plans, curricula and methodology.
- Familiarity with professional medical coding societies and resources.
- Strong oral communication skills and the ability to deliver presentations to large groups.
- Excellent writing skills that support guideline development and ability to deliver effective training materials for all clinical specialties to be utilized by medical coding staff.
- Experience working with physicians regarding documentation guidelines and requirements.
- Experience working in team environment and/or developing teams.
- Ability to share knowledge in an effective way that enhances learning and application of new skills.
- Ability to use independent judgment and to manage and impart confidential information in all compliance related issues.
- Knowledge of organizational structure, workflow and operating procedures with a high volume medical billing practice environment.
- Skilled in the use of computers preferably PC-based operating environment working with Microsoft Office products such as Excel, Word, Power Point and Access.Skilled in use of Cerner, IDX and TES Claims Manager (electronic editing and medical coding auditing systems).
- Experience working in an academic medical center.
- Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
- Must pass a pre-employment criminal background check.
- Fingerprinting, and subsequent clearance, is required.
- Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.
- Must obtain annual influenza vaccination.
- If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen. Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.
Working Conditions and Physical Effort
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required.
- No or very limited exposure to physical risk.