HIM Inpatient Coding Auditor

POSITION SUMMARY:

Conducts inpatient coding quality audits to validate code assignment is supported by clinical documentation in the medical record. Highly proficient in the proper assignment of ICD-10-CM and PCS codes.

KEY RESPONSIBILITIES:

• Performs coding audits of a wide variety of complex inpatient records to validate the ICD-10-CM, PCS codes, MS-DRG and/or APR DRG assignments.
• Provides written, detailed rationale and supporting evidence for recommendations on audit findings.
• Delivers educational feedback to coding staff regarding audit findings.
• Provides guidance to coding staff and management in identifying and resolving coding issues.
• Identifies documentation improvement opportunities that impact coding accuracy.
• Initiates physician queries for clarification of documentation in the medical record to achieve accurate code assignment.
• Collaborates with the clinical documentation improvement team for conflicts between code assignments.
• Reviews and researches billing edits.
• Assists with DRG denials from payers including researching and writing appeal letters.
• Ability to interpret Medicare and NCCI guidelines, National and Local Coverage Determinations to support coding compliance.
• Maintains a minimum of 95% accuracy on all coding audits.
• Maintains productivity standard of approximately 20 inpatient coding reviews per day.
• Performs other duties as assigned including training/mentoring of new staff and performing research related to special projects

REQUIRED KNOWLEDGE & SKILLS:

• Comprehensive understanding of coding guidelines, Coding Clinics and appropriate coding references along with the ability to employ these coding resources to audit findings.
• Excellent interpersonal verbal and written communication skills to accurately relay information to internal and external customers.
• Excellent organizational skills with ability to trend and track audit findings effectively.
• Excellent problem solving skills, the ability to work independently, and to perform under pressure in a teamwork manner with diplomacy and tact.
• Proficient computer and technical skills, along with experience using MS Word, Excel and PowerPoint.
• Ability to meet assigned deadlines.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

1. Education: Associates degree in Health Information (RHIT), or associates degree in applicable healthcare field.
2. Experience 3-5 years progressive coding experience in acute care hospital setting, including auditing
3. Certification/Licensure: AHIMA certification required, such as RHIA, RHIT or CCS,
4. Software/Hardware: Meditech and 3M 360 experience required; Cerner experience helpful.
5. Other: This is a remote position, and must live within a Steward hiring state.
6. Travel: Expected travel is up to 10%. Education and/or company growth.