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