HIM Outpatient Coding Auditor
Conducts outpatient 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, ICD PCS, CPT, HCPCS, and modifier codes.
- Performs coding audits of a wide variety of complex outpatient services including outpatient surgical, observation, emergency department, diagnostic outpatient, clinic, and series accounts. Also prefer experience in interventional radiology, E&M leveling and coding of injections and infusions.
- 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.
- Reviews and research billing edits.
- 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 for outpatient coding reviews, dependent upon type of review.
- Emergency Department – 8 per hour
- Same Day Surgery – 4 per hour
- Observation – 4 per hour
- Cardiac Cath/IVR – 3 per hour
- Ancillary – 20 per hour
- Oncology Infusions – 6 per hour
- Wound Care – 5 per hour
- 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, CCI edits, Coding Clinics and CPT assistant, along with ability to employ 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 or AAPC certification required, such as RHIA, RHIT, CCS, CIRCC, CPC, COC
- Software/Hardware: Meditech and 3M 360 experience required
- 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.